Laserfiche WebLink
Appendix 7 <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Testing Report Form <br /> TESTING TYPE ❑ Installation ❑ Repair ❑✓ 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10156811 1/8/26 <br /> Facility Name <br /> Safeway 2707 <br /> Facility Address City ZIP Code <br /> 6425 N Pacific Ave Stockton 95207 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> Service Station Systems (408) 971-2445 <br /> Mailing Address <br /> 680 Quinn Ave San Jose CA 95112 <br /> Service Technician Performing Testing <br /> Kristopher Bell <br /> Contractor License Number <br /> 485184 <br /> ICC Certification ICC Expiration Date <br /> 8833000 1/8/27 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> Franklin Fueling # 1004933708 6/11/26 <br /> OPW#1192275 4/28/27 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> PE11200 Drop Tubes <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that the OPE was tested in accordance with California Code of Regulations, <br /> title 23, division 3, chapter 16, section 2665; that required supporting documentation, <br /> including calibration charts, is attached; and all information contained herein is accurate. 1 <br /> understand that test procedures must be made available upon request by the governing <br /> authority. <br /> E <br /> rvice Technician Signatur1e� Date Total # of Pages <br /> �� 1/8/26 2 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification, OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br />