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Underground Storage Tank <br />Monitoring System Certification Form <br />Page 1 of 19 <br />TYPE OF ACTION Installation Repair 12 Month <br />1. FACILITY INFORMATION <br /> <br />CERS ID <br />10181479 <br />Certification Date <br />2023-08-14 <br /> <br />Facility Name <br />Mid City Ca FO Regen <br /> <br />Facility Address <br />13850 Devries Road <br />City <br />Lodi <br />ZIP Code <br />95242 <br /> <br />2. SERVICE TECHNICIAN INFORMATION <br /> <br />Company Performing the Certification <br />SunWest Engineering Constructors, Inc. <br />Phone <br />(888) 588-8737 <br /> <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 /> <br />ICC Number <br />8296393 <br />ICC Expiration Date <br />2024-11-10 <br /> <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications Expiration Date <br />UST Service Technician 11/ 10/ 2024 <br />Pnumercator 03/15/2025 <br /> <br /> <br /> <br /> <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 /> <br />Service Technician Signature <br /> <br />Date <br />2023-08-14 <br />Total # of Pages <br />19 <br /> <br />SA-23962