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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 />10456027 <br />Certification Date <br />12/17/2024 <br />Facility Name <br />National Petroleum - Tracy 76 <br />Facility Address <br />2420 W. Grantline Rd. <br />City <br />Tracy <br />ZIP Code <br />95377 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Certification <br />Elite IV Contractors <br />Phone <br />(209)-461-6337 <br />Mailing Address <br />2535 Wigwam Dr. Stockton, CA. 95205 <br />Service Technician Performing Test <br />Benjamin Malaspina <br />Contractor/Tank Tester License Number <br />1001331 <br />ICC Number <br />9519380 <br />ICC Expiration Date <br />06104/2026 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Veeder-Root C27440 <br />12/14/2026 <br />4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <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 SignatureDate <br />12/17/2024 <br />Total # of Pages <br />2 <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 />