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Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair N 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10399867 6/23/2022 <br /> Facility Name <br /> Hunt & Sons Arch Rd. Cardlock <br /> Facility Address City ZIP Code <br /> 4733 S. Hwy 99 Frontage Rd. Stockton <br /> , SERVICE TECHNICIAN INFORMATION' <br /> Company Performing the Certification Phone <br /> Donlee Pump Company (209) 537-9396 <br /> Mailing Address <br /> 2825 Railroad Ave. Ceres, CA. 95307 <br /> Service Technician Performing Test <br /> Gerardo Perez <br /> Contractor/Tank Tester License Number <br /> 432039 <br /> ICC Number ICC Expiration Date <br /> 8962656 3/14/23 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Incon 9/21/22 <br /> Veeder Root 7/30/22 <br /> Vaporless LDT 890 5/17/24 <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 Date Total # of Pages <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 /> Pagel of 6 <br />