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Appendix VI <br />Underground Storage Tank <br />Monitoring System Certification Form <br />TYPE OF ACTION ā¯‘Installation Repair x12 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />10468777 <br />Certification Date <br />10/20/2021 <br />Facility Name <br />Pacificwest Petroleum Inc. (ARCO am/pm # 83333) <br />Facility Address <br />550 W Valpico Rd <br />City <br />Tracy <br />ZIP Code <br />95376 <br />2. SERVICE TECHNICIAN INFORMATION ==1 <br />Company Performing the Certification <br />Diamond Petroleum Services, Inc. <br />Phone <br />(925) 470-0803 <br />Mailing Address <br />3619 King Ct Antiioch, CA 94509 <br />Service Technician Performing Test <br />Guadalupe Sanchez <br />Contractor/Tank Tester License Number <br />1005444 <br />ICC Number <br />5250451 <br />ICC Expiration Date <br />04/01/2023 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Veeder-Root ATG Tecnician A30138 <br />09/29/2023 <br />VMI Vaporless LDT-890 Tester # 4068 <br />06/13/2023 <br />4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />I hereby certify that the monitoring system is operational in accordance with California Code of <br />Regulations, title 23, division 3, chapter 16, section 2638; that required supporting documentation is <br />attached; and all information contained herein is accurate. <br />Service Technician Signature <br />Date <br />10/20/2021 <br />Total # of Pages <br />24 <br />5. MONITORING SYSTEM AND PROGRAMMING <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 />