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Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION Ll Installation LJ Repair N 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10876678 06/11/2024 <br /> Facility Name <br /> 7-ELEVEN 41216 <br /> Facility Address city ZIP Code <br /> 770 W.Charter Way Stockton 95206 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification I Ph0� - <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 /> G�rtravt�� �Tark �es:er L �er7se N��mber <br /> Class A General Engineering 743160 <br /> IGC Number IGG Expiration Date <br /> 8361393 05/16/2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root:ATG Technician (1345334) 04/03/2025 <br /> Veeder Root:Red Jacket Mechanical Line Leak Detector(1345334) 08/10/2024 <br /> VMI:TLDT-5000 Tester(3802) 11/07/2025 <br /> Franklin Fueling:FE Petro Submersible Pumps (1004283708) 08/11/2024 <br /> OPW:EVR Phase 1 (104302) 01/04/2025 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> l hereby certify that the monitoring system is operational in accordance with California Code <br /> of Regularions, title 23, division 3, chapter 16, sec rion 2638; that required supporring <br /> documentation is attached; and all information contained herein is accurate. <br /> Service Technician Signature Date Total # of Pages <br /> 06/11/2024 7 <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 />