Laserfiche WebLink
Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION Installation ® Repair El 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10184191 05/19/2025 <br /> Facility Name <br /> A&A Gas And Food Mart <br /> Facility Address City ZIP Code <br /> 1330 E. Yosemite Ave Manteca 95336 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Elite IV Contractors (209)-461-6337 <br /> Mailing Address <br /> 2535 Wigwam Dr. Stockton, CA. 95205 <br /> Service Technician Performing Test <br /> Ernesto Esqueda <br /> Contractor/Tank Tester License Number <br /> 1001331-A <br /> ICC Number ICC Expiration Date <br /> 10399647 03/19/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder-Root Tech C35659 04/12/2026 <br /> 4. CERTIFfCATION 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 /> 05/19/2025 4 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 />