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Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION f0 Installation © Repair © 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS I❑ Certification Date <br /> 10181263 112/1612025 <br /> Facility Name <br /> Arco 6080 <br /> E85cility Address City ZIP Code <br /> E. Louise Ave. Lathrop 95330 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Nwestco LLC 925-551-7555 <br /> Mailing Address <br /> 6805 Sierra Court, Suite G,, Dublin, CA 94568 <br /> Service Technician Performing Test <br /> Gabriel Solorlo <br /> ContractorlTank Tester License Number <br /> 1073967 <br /> ICC Number ICC Expiration Date <br /> 10425282 9/14/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root ATG Tech Cert #C32271 6/27/2026 <br /> VMI MLLD Tech Cert #5355 6/312027 <br /> VMI LDT890 Tech Cert#5356 6/3/2027 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 hereby certify that the monitoring system is operational in accordance with California Code <br /> of Regulations, tide 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 /> - 12/16/2025 6 <br /> CERS = California Environm_e�l 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 />