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Appendix 5 <br /> Underground Storage Tank <br /> Release Detection Equipment Testing Report Form <br /> TESTING TYPE ❑ Installation ❑ Repair 0 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181579 01/23/2026 <br /> Facility Name <br /> TRACY U.S.D <br /> Facility Address City ZIP Code <br /> 1975 W. LOWELL AVE TRACY 95376 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> ECO-CHEK Compliance Inc 888-500-2435 <br /> Mailing Address <br /> P.O. Box 1394, Lafayette Ca 94549 <br /> Service Technician Performing Testing <br /> Edward Stearns <br /> Contractor License Number <br /> 14-1760 Ex. 9/30/2028 <br /> ICC Certification ICC Expiration Date <br /> 8883080-UT 11/06/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> Ed Stearns Veeder Root A31048 9/26/2027 <br /> Ed Stearns Incon 1009893708 12/30/2026 <br /> Bryan Kilby OPW LMS23183 12/14/2026 <br /> Bryan Kilby ICC 9823281- UT 10/20/2027 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that all equipment identified in this form has been tested in accordance with <br /> California Code of Regulations, title 23, division 3, chapter 16, section 2663; that required <br /> supporting documentation is attached; and all information contained herein is accurate. <br /> Service Technician Signature r; _ Date Total # of Pages <br /> 01/23/2026 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, UDC = Under- <br /> Dispenser Containment, UST = Underground Storage Tank, VPH = Vacuum/Pressure/Hydrostatic <br /> Page 1 of 6 <br />