Laserfiche WebLink
Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION Ll Installation J Repair (W-j 12 Month <br /> 9. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10181341 11/13/2025 <br /> Facility Name <br /> CHEVRON#99840(N31) <br /> Facility Address City ZIP Code <br /> 4344 E WATERLOO RD @ 99 STOCKTON 95215 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Tanknology,Inc. 800-964-1250 <br /> Mailing Address <br /> 11000 N Mopac Expy#500 Austin, Tx 78759 <br /> Service Technician Performing Test <br /> Jesus Saldivar <br /> Contractor/Tank Tester License Number <br /> Class A General Engineering 743160 <br /> ICC Number ICC Expiration Date <br /> 8361393 05/12/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root:ATG Technician (1345334) 03/31/2027 <br /> Franklin Fueling:Phil-Tite EVR Ph 1 Systems(1004283708) 07/10/2026 <br /> VMI:TLDT-5000 Tester(3802) 10/24/2027 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST a <br /> 1 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 Date Total # of Pages <br /> f 11/13/2025 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 />