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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 /> 10403278 2023-02-28 <br /> Facility Name <br /> Lodi CA FO Term (Intl) <br /> Facility Address City ZIP Code <br /> 2500 West Turner Road Lodi 95242 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> SunWest Engineering Constructors, Inc. (888) 588-8737 <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 2024-11-10 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> VMI 08/21/2024 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING <br /> 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 /> 2023-02-28 17 <br /> Page 1 of 17 <br />