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Appendix VI <br />Underground Storage Tank <br />Monitoring System Certification Form <br />TYPE OF ACTION ❑ Installation ❑ Repair 0 12 Month <br />1. FACILITY INFORMATION <br />CERS ID Certification Date <br />10181485 2-24-23 <br />Facility Name <br />YRC Frieght #813 (Tracy) <br />Facility Address City ZIP Code <br />1535 East Pescadero Avenue Tracy 95304 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Certification Phone <br />Nwestco LLC (800) 339-9930 <br />Mailing Address <br />2209 Zeus Court, Bakersfield, CA 93308 <br />Service Technician Performing Test <br />Rockland Kirk <br />Contractor/Tank Tester License Number <br />1073967 <br />ICC Number <br />10241356 <br />ICC Expiration Date <br />9-29-24 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />FFS EVR Phase 1 Systems <br />10-16-24 <br />OPW UST EVR <br />2-15-25 <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 />Tie <br />Date <br />2-24-23 <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 />Page 1 of 6 <br />