Laserfiche WebLink
Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ® Installation ❑ Repair ❑ 12 Month <br /> 1. FACILITY INFORMATION _ <br /> CERS ID Certification Date <br /> 10184725 05/24/2024 <br /> Facility Name <br /> West Valley Auto Service <br /> Facility Address City County Zip Code <br /> 2615 Grantline Rd. Tracy San Joaquin 95304 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Elite IV Contractors 209 461-6337 <br /> Mailing Address <br /> 2535 Wigwam Dr Stockton CA <br /> Contractor/Tank Tester License <br /> Number 1001331 <br /> Service Technician Performing Test <br /> Benjamin Malaspina <br /> ICC Number ICC Expiration Date <br /> 9519380 06/17/2024 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer& Test Equipment Training Certifications Expiration Date <br /> FFS EVR Phase 1 VR-101 1019683711 10/23/2025 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components) Tested <br /> Hydrostatic Diesel and 91 Spill Container <br /> 5. CERTIFICATION BY THE SERVICE TECHNICIAN CONDUCTING THE TEST <br /> /hereby certify that each spf/l conta/ner was tested In accordance w/th Calffomis Code of <br /> Regulations, tide 23, div/sion 3, chapter 16, section 2637.1;that required supporting documentation <br /> /s attached,•and all fnformagon contained herWn is accurate. /understand that test procedures shall <br /> be made a vaf/able upon request by the goveming authority. <br /> Service Technician Signature /G����/���. Date Total #of Pages <br /> 05/24/2024 2 <br /> CERS= California Environmental Reporting System, GPH= Gallons Per Hour, ID= Identification, ICC= <br /> International Code Council <br />