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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Page 1 of 6) This form must be used to document testing and servicing of underground storage tank (UST) monitoring equipment. A copy of this form must be provided to the UST owner or operator. The owner or operator must submit a copy of this form to the local agency regulating the USTs within 30 days of the date of the monitoring system certification . I . FACILITY INFORMATION CERS ID Date of Monitoring System Certification 10151123 10/4/2019 Business Name (Same as Facility Name or DBA-Doing Business As) Building # Sprint Stockton Business Site Address Tcity ZIP Code 3807 Coronado Ave . I Stockton 95204 II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of Company Performing the CertificationPhone # Jauregui & Culver Inc . ( 760) 743 -0518 Mailing Address 959 W. Mission Ave . , Escondido , CA 92025 Name of UST Service Technician Performing the Certification (Print as shown on the ICC Certification) Benjamin Jauregui Contractor I Tank Tester License # ICC Certification # ICC Certification Expiration Date 708231 8277373 9/ 12/2021 Monitoring System Training and Certifications List all applicable certifications. Expiration Date Veeder- Root 1 /5/2020 III . RESULTS OF TESTING I SERVICING Indicate and attach the following reports if the monitoring equipment is capable of generating either. Y N NA �x Monitoring System Set-up ❑X Alarm History Report Was any monitoring equipment replaced ? F ❑X El (If "Yes, " identify the specific devices replaced and list the manufacturer and model for all replacement parts in section IV below.) Was damage , debris , or liquid found inside any secondary containment systems? El R El (If "Yes, " describe what was found in section IV below.) Is all monitoring equipment operational per manufacturer's specifications ? F ❑ F (If "No, " describe why in section IV below.) IV. COMMENTS If directed to use this section, describe how and when the issues were or will be corrected. RE " EL. LJ NVIRONMEE TAIm. .-1iEAIs I m DEPART A : N V. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING hereby certify that the equipment identified in this document was inspected/serviced in accordance with California Code of Regulations , Title 23 , Division 3 , Chapter 16, Section 2638 and all information contained herein is true and accurate. Attached to this certification is information (e. g . , manufacturers' checklists , monitoring system set-up , alarm history report, etc . ) necessary to verify that this information and the site plan showing the layout of UST system is complete and accurate. UST Service Technician Signature CERS = California Environmental Reporting System, ID = Identification, ICC = Intemational Code Coundl, Y = Yes, N = No, NA = Not Applicable