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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 Certification Date <br /> 10180759 4/16/2025 <br /> Facility Name <br /> AXIS #6822 <br /> Facility Address City ZIP Code <br /> 2132 MARIPOSA RD STOCKTON 95205 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> TANK-TEK ENVIRONMENTAL CORP 951.779.4999 <br /> Mailing Address <br /> PO BOX 5850, RIVERSIDE CA 92517 <br /> Service Technician Performing Test <br /> ROBERT SLUNAKER <br /> Contractor/Tank Tester License Number <br /> 803705 <br /> ICC Number ICC Expiration Date <br /> 8041107 3/4/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> VMI LDT-890 CERT #4023 1/26/2027 <br /> VMI MLLD CER #4022 1/26/2027 <br /> VEEDER-ROOT TLS-3XX 2/16/2027 <br /> RED JACKET LLD B37997 2/24/2027 <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 Date Total # of Pages <br /> �� 4/16/2025 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 />