Laserfiche WebLink
Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION 52 Installation ❑ Repair ❑ 12 Month <br /> 1 . FACILITY INFORMATION <br /> CERS ID 10407034 Certification Date <br /> 04/24/2025 <br /> Facility Name Pilot 618 Ripon <br /> Facility Address City RI ZIP Code <br /> 1501 Jack Tone Rd, Ripon Ripon 95366 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Jones Covey Group, Inc. 909-972-7581 <br /> Mailing Address9595 Lucas Ranch Rd. Rancho Cucamonga, CA 91730 <br /> Service Technician Performing Test <br /> johnny williams <br /> Contractor/Tank Tester License Number <br /> 804431 A,B HAZ <br /> ICC Number 10351367 ICC Expiration Date <br /> 05/23/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root atg 10/17/2026 <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 /> Digitally signed by:Johnny WilliamsIN <br /> Johnny Williams /. CN US O=J n=Johnles Covey Group,Inc OUIa Service Department 04/24/2025 6 <br /> Date:2025.05.06 10:44:49-07'00' <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 />