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gp <br /> Qntzi <br /> rt For <br /> TYKE aFCO Instal ation Raiff Mantle <br /> I. FACILITY-IREPEMA-MOMN <br /> CERS ID Test Date <br /> 10181435 10/03/2022 <br /> I=acilit . Name <br /> SMK Chevron <br /> Facility Address Cit E ZIP Code <br /> 601 E Kettlemen Lodi 95240 <br /> 2, SERVICE TECHNICIAN NEM&M <br /> Company Performin the Test Phone <br /> Elite IV Contractors (209) 461-6337 <br /> M a i I i i 0_6dO ess <br /> 2535 Wigwam Dr. Stockton, CA 95205 <br /> Service Technician Per€ormino lest <br /> Michael Kennard <br /> Gor tactorlTan c Tester License Number <br /> 1001331 <br /> ICC Number ICC E `ration L)aje <br /> 5254811 07/06/2023 <br /> 3. 7R1�lKING AN. CERTOGATIONS <br /> Manufacturer and Test Egment Trainina�Certificatin_ns Expiration Date <br /> ICC Service Tech #5254811 07/06/2023 <br /> CNI #4906 08/29/2024 <br /> F-- <br /> 4, T RU NN QRMATIQN <br /> Test Procedures Used ggMponents Tested <br /> Hydrostatic 87 East Fill Bucket -.-.-.-- <br /> 5. CERTIFICATION BY SERVICE TECHNIC'IAA"GC�I�f]t1CTl�1C IEST <br /> I hereb c r if a h snill " r e, dance wi h I'f ni d_e_af <br /> r" eYJ ! t n 9977 in <br /> dwumen ntained herein-is.accurate I understand <br /> that test rarocerh,re5 shall be►Wade av I fife <br /> Service Tec nic'an Si nature Date Total #of Pages <br /> 10/03/2022 2 <br /> �_= Californi Environmental R o L�_stem.!@_=_identific tion IC _,=�Interrtational Code <br /> uracil. <br />