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<br />Appendix VI <br />Underground Storage Tank <br />Monitoring System Certification Form <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 /> <br />Page 1 of 6 <br />TYPE OF ACTION ☐☐☐☐ Installation ☐☐☐☐ Repair ☒☒☒☒ 12 Month <br />1. FACILITY INFORMATION <br /> <br />CERS ID <br />10184915 <br />Certification Date <br />11/20/2024 <br /> <br />Facility Name <br />Kesar Petroleum Inc. <br /> <br />Facility Address <br />717 W Eighth St. <br />City <br />Stockton <br />ZIP Code <br />95206 <br /> <br />2. SERVICE TECHNICIAN INFORMATION <br /> <br />Company Performing the Certification <br />Pinnacle Fuel Compliance <br />Phone <br />408-206-9840 <br /> <br />Mailing Address <br />P.O. Box 32849 <br />Service Technician Performing Test <br />Jeff Conger <br />Contractor/Tank Tester License Number <br />90-1116 <br /> <br />ICC Number <br />1081782 <br />ICC Expiration Date <br />11/01/2026 <br /> <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications Expiration Date <br />Veederoot TLS-3XX 1/11/2025 <br />Franklin Fueling – FE Petro 2/22/2025 <br />Vaporless Manufacturing LDT-890 Tester 9/5/2026 <br />Vaporless Manufacturing LD Installation & Replacment 9/5/2026 <br />Veederoot-Red Jacket Mechanical Line Leak Detectors 9/11/2025 <br /> <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 /> <br />Service Technician Signature <br /> <br />Date <br />11/20/2024 <br />Total # of Pages <br />14 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />