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COMPLIANCE ISSUES : YES �!Certificatlon Type . Complete 190717-601 <br /> yUNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 1 of 6) <br /> This form must be used to document testing and servicing of underground storage tank (UST) monitoring equipment. A copy <br /> 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 <br /> a enc re ulatin the USTs within 30 days of the date of the monitoring system certification . <br /> Is FACILITY INFORMATION <br /> CERS ID Date of Monitoring System Certification <br /> 10181479 108/21 / 19 <br /> Business Name (same as Facility Name or DBA-Doing Business As) Building # <br /> Mid City Ca FO Regen I KINGCA <br /> Business Site Address City ZIP Code <br /> 13850 Devries Road Lodi 95242 <br /> 11 . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION ' <br /> Name of Company Performing the Certification Phone # <br /> SunWest Engineering Const. , Inc. (888) 588-8737 <br /> Mailing Address <br /> 4780 Cheyenne Way, Chino, CA 91710 <br /> Name of UST Service Technician Performing the Certification (Print as shown on the iCC Certification) <br /> Kraig Kinder <br /> Contractor / Tank Tester License # ICC Certification # ICC Certification Expiration Date <br /> 703190 8296393 12/7120 <br /> Monitoring System Training and Certifications List all applicable certifications. Expiration Date <br /> Veeder Root Cert#C23338 9/24119 <br /> III . RESULTS OF TESTING 1 SERVICING <br /> Indicate and attach the following reports if the monitoring equipment is capable of generating either. Y N NA <br /> ® Monitoring System Set-up ® Alarm History Report <br /> Was any monitoring equipment replaced? V1 FJ <br /> (if "Yes, " identify the specific devices replaced and list the manufacturer and model for all replacement parts in section 1V below.) <br /> Was damage , debris , or liquid found inside any secondary containment systems? <br /> (If "Yes, " describe what was found In section /V below.) <br /> Is all monitoring equipment operational per manufacturer's specifications? 0 El El <br /> (if "No, " describe why in section IV below.) <br /> IV. COMMENTS - , <br /> If directed to use this section, describe how and when the issues were or will be corrected. <br /> VA CERTIFICATION BY UST SERVICETECHNICIAN CONDUCTING THIS TESTING <br /> I hereby certify that the equipment identified in this document was inspected/serviced in accordance with California Code of <br /> Regulations , Title 23, Division 3, Chapter 16, Section 2638 and all information contained herein is true and accurate . Attached to <br /> this certification is Information (e.g. , manufacturers' checklists , monitoring system set-up, alarm history report, etc.) necessary <br /> to verify that this information and the site plan showing the layout of UST system is complete and accurate. <br /> UST Service Technician Signature Digitally signed by Kraig Kinder <br /> Kraig Kinder Date : 2019 .08 . 21 11 : 15:45 -07'00' <br /> CERS = CaRibmia Environmental Reporting System, ID = Identification, ICC = International Code Council , Y = Yes, N = No, NA = Not Applicable <br /> QA/QC APPROVED <br /> 8/23/20199 : 19AMMegan Rodr <br />