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UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION FORM This form must be used to document testing and servicing of underground storage tank ( UST) monitoring equipment. A copy 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 agency regulating the USTs within 30 days of the date of the monitoring system certification . I . FACILITY INFORMATION CERS ID Date of Monitoring System Certification 10182249 1 - 17-2020 Business Name (Same as Facility Name or DBA — Doing Business As.) Building # VPP Fresno Ave Business Site Address City ZIP Code 1524 Fresno Ave Stockton 95206 II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of Company Performing the Certification Phone # CGRS ( 916 ) 991 - 1100 SOLUTIONS DELIVERED Mailing Address 5444 Dry Creek Road ; Sacramento , Ca . 95838 Name of UST Service Technician Performing the Certification (Print as shown on the ICC Certification.) Garrett Warren Contractor/Tank Tester License # ICC Certification # ICC Certification Expiration Date CSLB#803616 SWRB#06 -1672 18185019 9 -20 -21 Monitoring System Training and Certifications (List all applicable certifications.) Expiration Date B42126 Veeder-root 1 -21 -21 VMI LDT-890 Tester/ #3822 4-30-2020 III . RESULTS OF TESTING/SERVICING Indicate and attach the following reports if the monitoring equipment is capable of generating either. Y N NA 0 Monitoring System Set-up 0 Alarm History Report Was any monitoring equipment replaced? (If "Yes, " identify the specific devices replaced and list the manufacturer and model for all replacement parts in section IV ❑ EI ❑ below. Was damage, debris, or liquid found inside any secondary containment systems? ❑ ❑ (If "Yes, " describe what was found in section IV below.) Is all monitoring equipment operational per manufacturer' s specifications? EI ❑ ❑ (If "No, " describe why in section IV below.) IV. COMMENTS If directed to use this section, describe how and when the issues were or will be corrected. i I V. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the equipment identified in this document was inspected/serviced in accordance with California Code of Regulations , title 23 , division 3, chapter 16 , section 2638 and all information contained herein is true and accurate . Attached to this certification is information (e. g . , manufacturers ' checklists , monitoring system set-up, alarm history report, etc . ) necessary to verify that this information and the site plan showing the layout of UST system is complete and accurate . UST Service Technician Signature CERS = California Environmental Reporting System, ID = Identification, ICC = Intemational Code Council, Y = Yes, N = No, NA = Not applicable