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Appendix VI 210209-530 <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair 0 12 Month <br /> 1. FACILITY INFORMATION 71 <br /> CERS ID Certification Date <br /> 10403278 03/02/21 <br /> Facility Name <br /> Lodi CA FO Term (Intl) <br /> Facility Address City ZIP Code <br /> 2500 West Turner Road Lodi 95242 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> SunWest Engineering Const., Inc. (888) 588-8737 <br /> Mailing Address <br /> 4780 Cheyenne Way, Chino, CA 91710 <br /> Service Technician Performing Test <br /> Kraig Kinder <br /> Contractor/Tank Tester License Number <br /> CA-703190 <br /> ICC Number ICC Expiration Date <br /> 8296393 11/18/22 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Pnumercator 2/18/23 <br /> ICC designated Operator 11/18/22 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 hereby certify that the monitoring system is operational in accordance with California Code <br /> of Regulations, title 23, division 3, chapter 16, section 2638; that required supporting <br /> documentation is attached, and all information contained herein is accurate. <br /> Service Technician Signature Date Total # of Pages <br /> Kraig Kinder Digitally signed by Kraig Kinder 03/02/21 6 <br /> Date:2021.03.02 11:36:23-08'00' <br /> CERS = California Environmental Reporting System, GPH = Gallons Per Hour, ID = Identification, <br /> ICC = International Code Council, LLD = Line Leak Detector, NA = Not Applicable, SW = Single- <br /> Walled, UDC = Under-Dispenser Containment, UST = Underground Storage Tank, <br /> VPH = Vacuum/Pressure/Hydrostatic <br /> QA/QC APPROVED Page 1 of 6 <br /> 3/10/20211:49 PMTara Neig <br />