HomeMy WebLinkAboutTests Notification_5573WPUNDERGROUND STORAGE TANK
TANK AND LINE INTEGRITY TESTING, AND ENHANCED LEAK
DETECTION TEST NOTIFICATION FORM
OFFICE OF TANK TESTER LICENSING
OTTL@waterboards.ca.gov
Test notifications for testing tank and line integrity testing, and enhanced leak detection (ELD)
testing are required to be submitted to the Office of Tank Tester Licensing (OTTL) in accordance
with the California Code of Regulations, tile 23, chapter 17, section 2772. If changes to test
notifications occur after submittal to OTTL, please notify OTTL of those changes immediately.
Using this form, provide OTTL with the following information when submitting test notifications:
SUBMITTAL DATE:4/23/24
FACILITY INFORMATION
CERS ID Test Date and Time: 5/3/24 @ 8am
Facility Name: Fast Break Mobil
Facility Address: 4800 White Lane City: Bakersfield ZIP Code: 93309
TANK TESTER INFORMATION
Company Performing the Test: LEAK DETECTION TECHNOLOGIES Phone :8552555325 X 746
Mailing Address:2765 e WIEDING RD, TUCSON, AZ 85706
Licensee Name: RICARDO GONZALEZ
OTTL License #04-1695 Expiration Date: 05/31/26
TEST METHOD INFORMATION
Test Method: Components Tested
Enhanced Leak Detection Under Ground Storage Tank
System
Post Construction ELD: Is the form for post construction contractor statement attached?
√YES NO If no is selected, provide general contractor statement prior to testing.
Failure to comply and provide all of the above information may result in disciplinary action against
licensed tank tester. Please note that this notification does not waive the requirement for the 48-
hour notice to the local agency in accordance with the provisions of California Code of Regulations,
title 23, chapter 16, sections 2643(g) and 2644.1(a)(4).
June 2020