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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 3/6/2019 Business Name (Same as Facility Name or DBA-Doing Business As) Building # California Stop Business Site Address City ZIP Code 2224 S Manthey Rd Stockton , CA 195026 IL UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of Company Performing the Certification Phone # EPIC Environmental Environmental Compliance Systems , Inc . (415 ) 315 - 9638 Mailing Address 39120 Argonaut Way # 643 , Fremont , CA 94538 Name of UST Service Technician Performing the Certification (Print as shown on the ICC Certification) Brian Dunahay Contractor / Tank Tester License # ICC Certification # ICC Certification Expiration Date 956593 8021436- UT 12/ 16/2019 Monitoring System Training and Certifications List all applicable certifications. Expiration Date B42886 3/ 14/2019 3497 MLLD 3/4/2020 3498 LDT- 890 ) 3/4/2020 Ill . RESULTS OF TESTING / SERVICING Indicate and attach the following reports if the monitoring equipment is capable of generating either. Y N NA OX MonitoringSystem Set-upQX Alarm Histo Report Was any monitoring equipment replaced ? [I FX] 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? (if "Yes, " describe what was found in section IV below.) Is all monitoring equipment operational per manufacturer's specifications? ❑X ❑ ❑ (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. Small amount of liquid (water - condensation ) in Diesel STP - removed . V. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I 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 i i CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council, Y = Yes, N = No, NA = Not Applicable E