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Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ® 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10181479 2022-08-16 <br /> Facility Name <br /> Mid City Ca FO Regen <br /> Facility Address City ZIP Code <br /> 13850 Devries Road Lod i 95242 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> SunWest Engineering Constructors, 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 /> 703190 <br /> ICC Number ICC Expiration Date <br /> 8296393 2022-11-18 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Pnumercator 02/16/2023 <br /> UST Service Technician 01/22/2024 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING <br /> 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 Date Total# of Pages <br /> 2022-08-16 17 <br /> Page 1 of 17 <br />