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Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair F,/ 12 Month <br /> 1 . FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10141507 08 - 11 - 2021 <br /> Facility Name <br /> Manteca CO <br /> Facility Address City ZIP Code <br /> 430 W. Center Street Manteca 95336 <br /> 2 . SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification one <br /> SunWest Engineering Constructors , Inc . ( 888 ) 58 & 8737 <br /> Mailing Address <br /> 4780 Cheyenne Way , Chino , CA 91710 <br /> Service Technician Performing Test <br /> Kraig Kinder <br /> Contractor/Tank Tester License Number <br /> 703190 <br /> ICC Number ICC Expiration Date <br /> 8296393 11 - 18 - 2022 <br /> 3 . TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> VR TLS 3XX Technician North America 11 -28 -2021 <br /> 4 . CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 hereby certify that the monitoring system is operational in accordance with California Code <br /> of Regulations, title 23, division 3, chapter 16, section 2638; that required supporting <br /> documentation is attached; and all information contained herein is accurate. <br /> Service Technician Signature Date Total # of Pages <br /> 0 & 11 -2021 4 <br /> CERS = California Environmental Reporting System , GPH = Gallons Per Hour , ID = Identification , <br /> ICC = International Code Council , LLD = Line Leak Detector, NA = Not Applicable , SW = Single - <br /> Walled , UDC = Under- Dispenser Containment , UST = Underground Storage Tank , <br /> VPH = Vacuum/ Pressure/Hydrostatic <br /> Page 1 of 6 <br />