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120806-015 <br />AppendixVI <br />{Copies of Monitoring System CerO m ion form and UST Mordtoflrtg Plot Plan ava0aWe at € J .w tsrb v.} <br />MONITORING SYSTEM CERTIFICATION <br />For <br />!firs By AU Jur 4MYidn the State afGaVorrin <br />At uthan�ity Cited: Chapter 6.7, Health and Safety Cade; Chapter 16, DhWon 3, Me 23, California Code of <br />,�regutattairtsr <br />This farm must be used to document taft loaf se of mcadtoring sgtdpment_ A words ca►tifkcrdion or report must be prepared for <br />each monitorings control panel by the loohn who petiorms ties work. A car of this form must be dad to de tank System <br />oomer/operator. owrtorlop erator front submit a copy of lids ftxnt to the tocat agency regulating UST eystems vdlidn 30 days of test date. <br />A. Gonaml Information <br />r-aetityNwe: MR01000, 00 Mg.Na,, <br />a <br />Site A •X30 W. Straot W. Manteca zkx 95336 <br />Faotily act Pemw. V1110011t 99h9ft contact Phone No.: t ) 209439-0251 <br />voed"zootualn Date of Testinoon4aing: W4/12 <br />M Carti n • r certify, that the equipment IdenNtied in this document was lnapected/aerviced In accordance wttk the manufacturers' <br />8tnidak"am Atfaahed to ihte CarlHtcatton Is information (so manufackmaW chockhatall necessary to verify that tide information is correct <br />and a Plot plan akakving its layout of monkO ft equtphWhr. For any equipment capable of genenating mato reports, I have allaahed a <br />copy of the Mon, (ohm *all! that W System MVW B Alem history reW <br />Technician ftme pW: ftt bw BpcM signatum— <br />owtincown No.: A20642 1 $347$33 UT License, No.: 703190 <br />Teaft Company Name: SUNWEff Wg Af Na.:{ 9090 ) 594M0 <br />reatiig - ` 6 a,* 60 A Qjd "Ra,t- I Dsta of Testi ervift: 8 12412012 <br />Monitoring item Certification Page t of 4 12A01 <br />til a APPROVED' <br />9/17/2021:48 +.. <br />M of Marti<odnQ8 <br />