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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 /> CERS ID Test Date <br /> 10182111 02/24/26 <br /> Facility Name <br /> El Dorado Food Mart <br /> Facility Address City ZIP Code <br /> 2320 N. El Dorado St. Stockton 95204 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> Alltech Petro, Inc. (209) 559-1616 <br /> Mailing Address <br /> P.O. Box 4208 Sonora Ca, 95370 <br /> Service Technician Performing Testing <br /> Isaac Anderson <br /> Contractor License Number <br /> 1093213 <br /> ICC Certification ICC Expiration Date <br /> 8146912 10/16/26 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> Veeder-Tec ATG Technician #1336878 08/24/26 <br /> Vaporless LDT-890 LDT #2113 01/24/27 <br /> OPW #100456 04/22/26 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <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; an ll information contained herein is accurate. <br /> Service Technician Signature Date Total # of Pages <br /> 2/24/26 5 <br /> CERS = California Environment eporting System, GPH = Gallons Per Hour, ID = Identification, <br /> ICC = International Code Council, LLD = Line Leak Detector, NA = Not Applicable, UDC = <br /> UnderDispenser Containment, UST = Underground Storage Tank, VPH = <br /> Vacuum/Pressure/Hydrostatic <br /> Page 1 of 5 <br />