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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 /> 10181493 5/22/2024 <br /> Facility Name <br /> SOHAL #3 CHEVRON <br /> Facility Address City ZIP Code <br /> 2494 E. FREMONT ST STOCKTON 95205 <br /> FI-SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> ECO CHEK COMPLIANCE 888-500-2435 <br /> Mailing Address <br /> PO BOX 1394 LAFAYETTE CA 94549 <br /> Service Technician Performing Test <br /> Edward Stearns <br /> Contractor/Tank Tester License Number <br /> 14-1760 Ex. 9/30/25 <br /> ICC Number ICC Expiration Date <br /> 8883080-UT 11/5/2024 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root A31048 7/29/2025 <br /> I ncon 1009893708 3/1/2025 <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 /> 15/22/2024 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 />