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190320-597 <br />UNDERGROUND STORAGE TANK <br />CERS =California Environmental Reporting System, ID= Identification, ICC = International Code Council, Y= Yes, N <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 />agency regulating the USTs within 30 days of the date of the monitoring system certification. <br />L FACILITY INFORMATION <br />CERS ID <br />Date of Monitoring System Certification <br />10181481 104/03/19 <br />Business Name (Same as Facility Name or DBA -Doing Business As) <br />Manteca CA FO REGEN <br />Building # <br />I MANTCA <br />Business Site Address City <br />ZIP Code <br />2551 E. Louise Ave. Lathrop <br />95330 <br />II. - 'UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br />Name of Company Performing the Certification <br />Phone # <br />SunWest Engineering Const., Inc. <br />(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 /CC Certification) <br />Kraig Kinder <br />Contractor I Tank Tester License # <br />ICC Certification # <br />ICC Certification Expiration Date <br />703190 <br />8296393 <br />12/7/20 <br />Monitoring System Trainin and Certifications List all applicable certifications. <br />Pnumercator 1D#11410 <br />Expiration Date <br />2/27/21 <br />111. RESULTS OF TESTING l SERVICING <br />Indicate and attach the following reports if the monitoring equipment is capable of generating either. Y <br />® Monitoring System Set-up ® Alarm History Report <br />N ' <br />NA <br />Was any monitoring equipment replaced? ❑ <br />(If "Yes,"identify the specific devices replaced and list the manufacturer and model for all replacement parts in section IV below) <br />❑ <br />Was damage, debris, or liquid found inside any secondary containment systems? ❑ <br />9 <br />❑ <br />(If "Yes, " describe what was found in section /V below.) <br />Is all monitoring equipment operational per manufacturer's specifications? ® <br />❑ <br />❑ <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 />V. CERTIFICATION BY UST SERVICE TECHNICIAN 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 Kraig Kinder Digitally signed by Kraig Kinder <br />Date: 2019.04.03 09:12:54 -07'00' <br />= No, NA = Not Applicable <br />