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RJPEIVED <br />2014 140808-186 <br />Appendix VI ENVIRONMENTAL <br />t t T <br />(Copies of ring System Certification forret and UST Monitoring Plot Plan a e at_ J Ovate oards.ca.faov.) <br />MONITORING SYSTEM CERTIFICATION <br />For Use 4 M Jurisddlions f+irrthirr the SWe of CWWorrWa <br />Authodty Cited: Chapter 6.7, Health and Se 6, Division 3, 77tfa 23, C.afffornia Code of <br />Regulations <br />This form must be used to document testing and servicing of monitoring ewipment. A separate certification or report must be prepared for <br />each monitoring control parcel by the techwho performs the wodL A copy of this form must be provided to the tank system <br />ownerloperator. The owner/operator must submit a copy of this form to the beef agency regulaft UST systems within 30 days of test date. <br />A. General Information <br />Facility e: Mid City Ca FO Ream Eft. Na: KINGCA <br />site Awr : 13850 Devries Road city: Lode zip: 95242 <br />Facitfty contact Person: Jonathan P 1e tom.: 916-439-6042 <br />mak~ei of vino : Pnuemercator TMS -2 ()ate of T drq: 9/11/14 <br />C. Certification - I cartfly that the equipment Identified .; W In accordarice <br />guidelines. Attached to We certification Is kftnnedon (". manufacknoW dwckftft) necessary to verity that Oft hdormallon Is correct <br />W a Plot rc showing the layoutof W u equipmeft For wry equipment <br />PPaul <br />copy of the report.- ~0 UWAPPW. m System ad -up 19 Alarm 1 r ► mt i PA I«I«t <br />Technician Nam 0": Paul Signature:2104 M' <br />..: : 970319-0License. <br />. g4 a <br />o -W W 48 ..>Tgs*V company Addresa. 4780 Che enne Way Chino, Ca. 917 10 Des of TestinglServieft: 9/11/14Document Reviewed 9/12/20149:17 ANIJustin TrelstadMonitoring System cerwilostlen Pap I of 4 law <br />QAIQC APPROVED <br />RO V ED <br />9/18/201412:19 PMMike P. <br />1 2/21/07 <br />