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Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION ❑Installation Repair x12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10422475 03/25/2024 <br /> Facility Name <br /> Yosemite Avenue A RCO Am Pm <br /> Facility Address City ZIP Code <br /> 1711 E. Yosemite A e Manteca 95336 <br /> 2. SERVICE TECHIS ICIAN INFORMATION <br /> Company Performin the Certification Phone <br /> Diamond Petrolleurr Services, Inc. (925) 470-0803 <br /> Mailing Address <br /> 3619 King Ct Antiio h, CA 94509 <br /> Service Technician F erforming Test <br /> Guadalupe Sanchez <br /> Contractor/Tank Tes er License Number <br /> 1005444 <br /> ICC Number ICC Expiration Date <br /> 5250451 04/01/2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and TE st Equipment Training Certifications Expiration Date <br /> Veeder-Root ATG I echnician #A30138 09/25/2025 <br /> VMI Vaporless LDT 890 Tester# 4068 06/21/2025 <br /> 4. CERTIFICATIOh BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify tha t the monitoring system is operational in accordance with California Code of <br /> Regulations, title 2 3, division 3, chapter 16, section 2638; that required supporting documentation is <br /> attached;and all ir,formation contained herein is accurate. <br /> Service Technician Signature Date Total # of Pages <br /> -� 03/25/2024 17 <br /> 011 <br /> 5. MONITORINGS STEM AND PROGRAMMING <br /> CERS = CaliforniaEnvironmental 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 = U der-Dispenser Containment, UST = Underground Storage Tank, <br /> VPH = Vacuum/P essure/Hydrostatic <br /> Page 1 of 6 <br />