Laserfiche WebLink
Appendix VI <br />Uploaded in CERS 4/8/2024 <br />Underground Storage Tank <br />Monitoring System Certification Form <br />TYPE OF ACTION ❑ Installation ❑ Repair ❑✓ 12 Month <br />1. FACILITY INFORMATION <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 = <br />CERS ID <br />10181545 <br />Certification Date <br />3/5/2024 <br />Facility Name <br />SAN JOAQUIN CO CORP YARD <br />Facility Address <br />1810 E. HAZELTON AVE �7STOCKTON <br />City <br />ZIP Code <br />95205 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Certification <br />Afforda Test <br />Phone <br />209-744-0112 <br />Mailing Address <br />416 2nd St Galt CA 95632 <br />Service Technician Performing Test <br />Edward Stearns <br />Contractor/Tank Tester License Number <br />CSLB: 958763 Lic # 14-1760 <br />ICC Number <br />8883080 -UT <br />ICC Expiration Date <br />11/05/20 <br />3. TRAINING <br />AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Veeder Root A31048 <br />7/29/2025 <br />Incon 1009893708 <br />11/26/2024 <br />4. CERTIFICATION BY SERVICETECHNICIAN <br />CONDUCTING <br />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 />(9.dward 03te <br />Date <br />3/5/2024 <br />Total # of Pages <br />6 <br />Walled, UDC UDC = Under -Dispenser Containment, UST = Underground Storage Tank, <br />VPH = Vacuum/Pressure/Hydrostatic <br />Page 1 of 6 <br />