Laserfiche WebLink
Appendix VI <br />Underground Storage Tank <br />Monitoring System Certification Form <br />TYPE OF ACTION ❑ Installation ❑ Repair <br />0 12 Month <br />210302-332 <br />1. FACILITY INFORMATION <br />CERS ID <br />10181481 <br />Certification Date <br />04/20/21 <br />Facility Name <br />Manteca CA FO REGEN <br />Facility Address <br />2551 E. Louise Ave. <br />City <br />Lathrop <br />ZIP Code <br />95330 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Certification <br />SunWest Engineering Const., Inc. <br />Phone <br />(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 <br />8296393 <br />ICC Expiration Date <br />11/18/22 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Pnumercator <br />2/16/22 <br />4. CERTIFICATION BY SERVICE TECHNICIAN `CONDUCTING TEST <br />I 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 <br />Kraig Kinder Digitally signed by Kraig Kinder <br />Date: 2021 .04.20 12:12:44 -07'00` <br />Date <br />04/20/21 <br />Total # of Pages <br />6 <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 />4/21/202111:39AMTara Neig <br />