Laserfiche WebLink
Appendix VII <br />Underground Storage Tank <br />Secondary Containment Testing Report Form <br />TYPE OF ACTION ® Installation ® Repair Q 6 Month ® 36 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />10154767 <br />Test Date <br />11-07-2023 <br />Facility Name <br />Lawrence Livermore National Laboratory 882-TFUD01 <br />Facility Address <br />15999 West Corral Hollow Road <br />City <br />Tracy <br />ZIP Code <br />95376 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Thornton Environmental Construction, Inc. <br />Phone <br />209-834-0792 <br />Mailing Address <br />P.O. Box 360833 Milpitas, CA 95036-0833 <br />Service Technician Performing Test <br />Brian Thornton <br />Contractor/Tank Tester License Number <br />CSLB #724513 A C-10 HAZ <br />ICC Number <br />#5024962 <br />ICC Expiration Date <br />02-23-2024 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Caldwell Sump Level Change Indicator <br />5-02-2026 <br />PEI RP 1200 <br />10-25-2026 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used Components Tested <br />PEI RP 1200 -Vacuum Tank interstice <br />PEI RP 1200 -Pressure Piping interstice <br />PEI RP 1200 -Hydrostatic Piping sump <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />I hereby certify that the secondary containment was tested in accordance with California <br />Code of Regulations, title 23, division 3, chapter 16, section 2637; that required supporting <br />documentation is attached; and all information contained herein is accurate. I understand <br />that test procedures shall be made available upon request by the governing authority. <br />Service Technician Signature <br />_ <br />Date <br />11-07-2023 <br />Total # of Pages <br />5 <br />CERS = California Environmental Reporting System, ICC = International Code Council, <br />ID = Identification, NA = Not Applicable, UDC = Under -Dispenser Containment, <br />Page 1 of 5 <br />