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Appendix VI <br />Underground Storage Tank <br />Monitoring System Certification Form <br />TYPE OF ACTION ❑ Installation ® Repair ❑ 12 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />10399867 <br />Certification Date <br />101W23 <br />Facility Name <br />Hunt & Sons LLC <br />Facility Address <br />4733 S. Hwy 99 Frontage Rd. <br />City <br />Stockton <br />ZIP Code <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Certification <br />Donlee Pump Company <br />Phone <br />(209) 537-9396 <br />Mailing Address <br />2825 Railroad Ave. Ceres, CA. 95307 <br />Service Technician Performing Test <br />Mario Romero <br />Contractor/Tank Tester License Number <br />ICC Number <br />8034353 <br />ICC Expiration Date <br />10/11/24 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Veeder Root <br />9/27/24 <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 <br />1/ /ZV,9 �'"9_ <br />Date <br />— 1111 <br />Total # of Pages <br />- G_ <br />CEVS = Califor is 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 />