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Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑✓ 12 Month <br /> 1 . FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10181513 9/21 /2021 <br /> Facility Name <br /> SAN JOAQUIN REGIONAL TRANSIT <br /> Facility Address City ZIP Code <br /> 2849 MYRTLE STREET STOCKTON 95205 <br /> 2 . SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Afforda Test 209 - 744 - 0112 <br /> Mailing Address <br /> 416 2nd St Galt CA 95632 <br /> Service Technician Performing Test <br /> Edward Stearns <br /> Contractor/Tank Tester License Number <br /> 14 - 1760 Ex . 9 /30/23 <br /> ICC Number ICC Expiration Date <br /> 8883080 - UT 11 /6 /2022 <br /> 3 . TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root A31048 7/ 31 /23 <br /> Incon 1009893708 3/ 1 /2023 <br /> 4 . CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I 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 /> '' 9 /21 /2021 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 , SW = Single - <br /> Walled , UDC = Under- Dispenser Containment , UST = Underground Storage Tank , <br /> VPH = Vacuum /Pressure/Hydrostatic <br /> Page 1 of 6 <br />