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Appendix 5 <br />Underground Storage Tank <br />Release Detection Equipment Testing Report Form <br />TESTING TYPE ❑ Installation ® Repair ❑ 12 Month <br />1. FACILITY INFORMATION <br />Company Performing Testing <br />CERS 1D <br />Elite IV Contractors <br />Test Date <br />10180717 <br />2535 Wigwam Dr. Stockton, CA. 95205 <br />01/27/2026 <br />Facility Name <br />Contractor License Number <br />Morada Chevron Fast N Easy #60 <br />ICC Certification <br />Facility Address <br />City <br />ZIP Code <br />108787 N HWY 99 <br />Stockton <br />95212 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing Testing <br />Phone <br />Elite IV Contractors <br />(209)-461-6337 <br />Mailing Address <br />2535 Wigwam Dr. Stockton, CA. 95205 <br />Service Technician Performing Testing <br />Jordan Esqueda _- <br />Contractor License Number <br />1001331-A <br />ICC Certification <br />ICC Expiration Date <br />10611893 <br />07/21/2027 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications Training Expiration Date <br />Veeder-Root ATG Technician 09/30/2027 <br />14. CERTIFICATION 13Y SERVICE TECHNICIAN CONDUCTING TEST I <br />! 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 --,1 4— 1 Date Total # of Pages <br />01/27/2026 16 <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 />