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; COMPLIANCE ISSUES : No Certification Type : Complete 200213 -609 <br /> UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 1 of 6) <br /> This form must be used to document testing and servicing of underground storage tank ( UST) monitoring equipment. A copy <br /> of this form must be provided to the UST owner or operator. The owner or operator must submit a copy of this form to the local <br /> agency regulating the USTs within 30 days of the date of the monitoring system certification . <br /> I . FACILITY INFORMATION <br /> CERS ID Date of Monitoring System Certification <br /> 10403278 03/05/20 <br /> Business Name (Same as Facility Name or DBA -Doing Business As) Building # <br /> Lodi CA FO Term (1110 ) LODICA <br /> Business Site Address City ZIP Code <br /> 2 \g <br /> 500 est 'Turner Road Lodi 95242 <br /> II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of Company Performing the Certification Phone # <br /> SunWest Engineering Const. , lnc . ( 888) 588-8737 <br /> Mailing Address <br /> 4780 Cheyenne Wray, Chino, CA 91710 <br /> Name of UST Service Technician Performing the Certification (Print as shown on the ICC Certification) <br /> Ruben Becerra <br /> Contractor / Tank Tester License # ICC Certification # ICC Certification Expiration Date <br /> 703190 5302139 02-05-21 <br /> Monitoring System Training and Certifications List all applicable certifications. Expiration Date <br /> Pnuemercator 08-01 -20 <br /> EVO ( tincleak detection panel ) 02 - 17 -22 <br /> Ili . RESULTS OF TESTING i SERVICING <br /> Indicate and attach the following reports if the monitoring equipment is capable of generating either. Y N NA <br /> ® Monitoring System Set- up ® Alarm History Report <br /> Was any monitoring equipment replaced ? <br /> (If " Yes, " identily the specific devices replaced and list the manufacturer and model for all replacement parts in section iV below.) <br /> Was damage , debris , or liquid found inside any secondary containment systems? <br /> (If " Yes, " describe what was found in section IV below.) <br /> Is all monitoring equipment operational per manufacturer' s specifications? <br /> (If Wo, " describe why in section IV below.) <br /> IV . COMMENTS <br /> If directed to use this section, describe how and when the issues were or will be corrected. <br /> V. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING <br /> I hereby certify that the equipment identified in this document was inspected /serviced in accordance with California Code of <br /> Regulations , Title 23 , Division 3 , Chapter 16 , Section 2638 and all information contained herein is true and accurate . Attached to <br /> this certification is information (e . g . , manufacturers ' checklists , monitoring system set- up , alarm history report , etc . ) necessary <br /> to verify that this information and the site plan showing the layout of UST system is complete and accurate . <br /> UST Service Technician Signature Digitally signed by Ruben Becerra <br /> Ruben Becerra Date : 2020 . 03 . 05 10 : 23 : 23 -08'00 ' <br /> CERS = Califomiaa Environmental Reporting System, ID = Identification, ICC = International Code Council , Y = Yes, N = No, NA = Not Applicable <br /> QA/ QC APPROVED <br /> 3 / 6 /20208 : 18 AMTara Neig <br />