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Home My WebLink AboutREPAIR 2022 Appendix VIII Underground Storage Tank Spill Container Testing Report Form CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council Page 1 of 2 TYPE OF ACTION ܆܆ Installation ܆ Repair ܆ 12 Month 1. FACILITY INFORMATION CERS ID Test Date Facility Name Facility Address City ZIP Code 2. SERVICE TECHNICIAN INFORMATION Company Performing the Test Phone Mailing Address Service Technician Performing Test Contractor/Tank Tester License Number ICC Number ICC Expiration Date 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date 4. TEST PROCEDURE INFORMATION Test Procedures Used Components Tested 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST I hereby certify that each spill container was tested in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637.1; that required supporting documentation is attached; and all information contained herein is accurate. I understand that test procedures shall be made available upon request by the governing authority. Service Technician Signature Date Total # of Pages 10159161 10/3/2022 Jaco #7721 Fastrip #22 - North 4013 South H Street Bakersfield 93304 Nwestco LLC (800) 339-9930 2209 Zeus Court, Bakersfield, CA 93308 Aaron Perrigo 1073967 8485827 8485827 OPW 0148613 8/21/2024 Lake Test 87 ﬁll spill bucket 10/3/2022 2 Underground Storage Tank Spill Container Testing Report Form Additional copies of this page may be attached. Page 2 of 2 6. SPILL CONTAINER DETAILS Test Method Developed by ܆܆ Manufacturer ܆܆ Industry Standard ܆܆ Professional Engineer Test Type ܆܆ Pressure ܆܆ Vacuum ܆܆ Hydrostatic Tank ID Spill Container Manufacturer: Method of Cathodic Protection ܆܆ Nonmetallic ܆܆ Other ܆܆ Nonmetallic ܆܆ Other ܆܆ Nonmetallic ܆܆ Other ܆܆ Nonmetallic ܆܆ Other Is the spill container minimum capacity five gallons excluding riser volume? ܆܆ Yes ܆܆ No* ܆܆ Yes ܆܆ No* ܆܆ Yes ܆܆ No* ܆܆ Yes ܆܆ No* Method to keep spill container empty ܆܆ Drain ܆܆ Pump ܆܆ Other ܆܆ Drain ܆܆ Pump ܆܆ Other ܆܆ Drain ܆܆ Pump ܆܆ Other ܆܆ Drain ܆܆ Pump ܆܆ Other Spill Container Test Results ܆܆ Pass ܆܆ Fail ܆܆ Pass ܆܆ Fail ܆܆ Pass ܆܆ Fail ܆܆ Pass ܆܆ Fail Tank ID Spill Container Manufacturer: Method of Cathodic Protection ܆܆ Nonmetallic ܆܆ Other ܆܆ Nonmetallic ܆܆ Other ܆܆ Nonmetallic ܆܆ Other ܆܆ Nonmetallic ܆܆ Other Is the spill container minimum capacity five gallons excluding riser volume? ܆܆ Yes ܆܆ No* ܆܆ Yes ܆܆ No* ܆܆ Yes ܆܆ No* ܆܆ Yes ܆܆ No* Method to keep spill container empty ܆܆ Drain ܆܆ Pump ܆܆ Other ܆܆ Drain ܆܆ Pump ܆܆ Other ܆܆ Drain ܆܆ Pump ܆܆ Other ܆܆ Drain ܆܆ Pump ܆܆ Other Spill Container Test Results ܆܆ Pass ܆܆ Fail ܆܆ Pass ܆܆ Fail ܆܆ Pass ܆܆ Fail ܆܆ Pass ܆܆ Fail 1 8. COMMENTS Describe all answers marked “Other,” “No,” or “Fail” and each proposed remedy. * Mark here if: Spill containers do not have a minimum capacity of five gallons and require replacement. 87 OPW