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Appendix VI <br />Underground Storage Tank <br />Monitoring System Certification Form <br />TYPE OF ACTION ❑ Installation ❑ Repair r-�;] 12 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />10403278 <br />Certification Date <br />03-30-2022 <br />Facility Name <br />Lodi CA FO Term <br />Facility Address <br />2500 West Turner Road <br />City <br />Lodi <br />ZIP Code <br />95242 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Certification <br />SunWest Engineering Constructors, 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 />703190 <br />ICC Number <br />8296393 <br />ICC Expiration Date <br />11-18-2022 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />FFS Electronic Line Leak Detection Startup <br />06-07-2022 <br />OPW EVR AST and UST <br />06-26-2023 <br />Pneumercator Liquid Level Control and Leak Detection Systems <br />02-16-2023 <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 />Date <br />03-30-2022 <br />Total # of Pages <br />16 <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 />Page 1 of 16 <br />