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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM storage (Page <br /> ((UST) monitoring equipment. A copy <br /> This form must be use ovod to thetUSTlowne ng tlor opera t The owner oropera or must submit a copy <br /> of und <br /> of this form to the <br /> of this form must be p <br /> USTs within 30 days of the date <br /> local agency regulatY INFORMATION m of the monitoring <br /> system certifications <br /> ing the stem Certification <br /> FACILITY <br /> I ' Date of Monitoring Sy <br /> CERS ID 9/2/2020 <br /> 10165857Building # <br /> Business Name (Same as Facility Name or DBA-Doing Business As .) Zip : <br /> 7111ELEVEN # 19976 , MKT 2368 City : 85336 <br /> Business Site Address MANTECA <br /> I ST . @ NORpTH' GATE <br /> 1399 N . MAIN <br /> STORAGE TANK SERVICE TECHNI PhNFORMATION <br /> UNDERGROUNDe # <br /> Name of Company Performing the Certification (800) 800.4633 Ext. <br /> TANKNOLOGY INC . <br /> Mailing Address <br /> 11000 N . Mopac Expressway #500 , Austin , TX 78759 <br /> ertification (Print as shown on the ICC Certification •) <br /> Name of UST Service Technician Performing the CExpiration Date <br /> Clint Fuhrman ICC Certification # ICC Certification p <br /> Contractor/Tank Tester License # 8160945 5/2/2021 <br /> Class A General Engineering 743160 Ex 11 di Date <br /> rt List all a ticable certifications . 02/04/2022 <br /> Monitorin S stem Trainin and C <br /> Certification Exam 96735 <br /> Tanknology Certification Level III ATG Operability Training er04/25/2021 <br /> Veeder Root ATG Technician C26533 <br /> Ill. ' RESULTS OF TESTING/SERVICING Y N NA ' <br /> Indicate and attach the following reports if the mons Alarm History Report ,capable of generating either. <br /> W"! <br />