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Appendix VI Mal �ko <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION El Installation © Repair El 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID J U N 0 � 2025 Certification Date <br /> 10184157 5-9-2025 <br /> Facility Name ENVIRONMENTAL HEALTH <br /> Teichert Mobile Equipment PERMIT/SERVICES <br /> Facility Address City ZIP Code <br /> 120 Frank circle Stockton 195206 <br /> 12. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Armas Inc. (833) 432-1222 <br /> Mailing Address <br /> PO Box 1595 Vacaville CA 95695 <br /> Service Technician Performing Test <br /> Jacob Armour <br /> Contractor/Tank Tester License Number <br /> 1054181 <br /> ICC Number ICC Expiration Date <br /> 888483 10/13/2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root ATG Technician B34734 5-13-2025 <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 Signature Date Total # of Pages <br /> r . 5/9/2025 32 <br /> CERS = California Environmental Reporting System, GPH = Gallons Per Hour, 1D = 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 7 <br />