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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM (Pa e 1 of s) 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 1 / 10/2019 Business Name (Same as Facility Name or DBA-Doing Business As) Building # Arco 7147 Business Site Address City ZIP Code 1206 E . March Lane Stockton 95210 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of Company Performing the Certification Phone # Gettler Ryan Inc (925 ) 5514777 Mailing Address 6808 Sierra Ct . Dublin , CA 94568 Name of UST Service Technician Performing the Certification (Print as shown on the iCC Certification) David Rouse Contractor I Tank Tesler License # ICC Certification # ICC Certification Expiration Dale 220793 8292530 6/28/2020 Monitoring System Training and Certifications List all applicable cerlificallons. Expiration Dale Veeder Root TLS3XXX Technician 844848 III. RESULTS OF TESTING I SERVICING indicate and attach the following reports if the monitoring equipment is capable of generating either. TYN NA El Monitorin S stem Set-u Alarm Histo Re ort Was any monitoring equipment replaced? o(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? ❑ (1f "Yes, " describe what was found in section IV below.) Is all monitoring equipment operational per manufacturer's specifications? (if No, " describe why in section IV below.) ❑ ❑ IV. COMMENTS 1f directed to use this section, describe how and when the Issues were or will be corrected. =%E EIV El FEB 01 2019 ENVIRONMENTAL i TN DEPARTMEN V. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING 1 hereby certify that the equipment identified in this document was Inspectediserviced 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' the hats, monitoring system set-up, alarm history report, etc .) necessary to verily that this Information and tht site plan wing6ge layout of UST system Is complete and accurate, UST Service Technician Signature CERS = California Environmental Reporting System, ID = Identification, ICC = Intemational Code Council, Y = Yes, N = No, NA = Not Applicatie