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Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION x Installation Repair 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10422475 01/02/2023 <br /> Facility Name <br /> Yosemite Avenue ARCO Am Pm <br /> Facility Address City ZIP Code <br /> 1711 E.Yosemite Ave Manteca 95336 <br /> 2. SERVICE TECHNICIAN INFORMATION 771 <br /> Company Performing the Certification Phone <br /> Diamond Petroleum Services, Inc. (925) 470-0803 <br /> Mailing Address <br /> 3619 King Ct Antiioch, CA 94509 <br /> Service Technician Performing Test <br /> Guadalupe Sanchez <br /> rtractor/Tank Tester License Number <br /> 5444 <br /> ICC Number ICC Expiration Date <br /> 5250451 04101/2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder-Root ATG Technician #A30138 09/29/2023 <br /> VMI Vaporless LDT-890 Tester#4068 06/13/2023 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 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 Date Total #of Pages <br /> 01/0212023 16 <br /> S. 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 />