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Appendix 5 <br />Underground Storage Tank <br />Release Detection Equipment Testing Report Form <br />TESTING TYPE ❑ Installation 9 Repair ❑ 12 Month <br />1. FACILITY INFORMATION <br />Company Performing Testing <br />CERS ID <br />Test Date <br />10181541 <br />6-11-2026 <br />Facility Name <br />Service Technician Performing Testing <br />PACIFIC BELL TELEPHONE CO. DBA AT&T CALIFORNIA <br />Contractor License Number <br />Facility Address <br />City <br />ICC Expiration Date <br />ZIP Code <br />1812 Coley Ave. <br />Escalon <br />95320 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing Testing <br />Phone <br />Tait Environmental Services, Inc. <br />(714) 560-8222 <br />Mailing Address <br />11280 Trade Center Dr., Rancho Cordova, CA 95742 <br />Service Technician Performing Testing <br />Jaime Jauregui <br />Contractor License Number <br />588098 <br />ICC Certification <br />ICC Expiration Date <br />8340695 <br />07-16-2026 <br />13. TRAINING AND CERTIFICATIONS I <br />Manufacturer and Test Equipment Training Certifications I Training Expiration Date <br />Veeder Root - B48138 1 11-12-2026 1 <br />14. 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 Date Total # of Pages <br />6-11-2026 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 />