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Appendix A <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION © Installation ❑ Repair 0 12 month <br /> 1. FACILITY INFORMATION <br /> -CERS ID Certification Date <br /> 10399867 Y t <br /> Facility Name <br /> Hunt & Sons LLD <br /> Facility Address City ZIP Code <br /> 4733 S Hwy 99 Frontage Rd Stockton 95201 <br /> . SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Hunt Equipment LLD 89-5 7-9396 <br /> Mailing Address <br /> 285 Railroad Ave. <br /> Service Technician Performing Test <br /> Gerardo Perez <br /> Oontractor.rrank Tester License Number <br /> 1018253 <br /> ICC Number ICC Expiration Date <br /> 10250519 1315127 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root I2 I27 <br /> OP 3l20/27 <br /> Franklin Fueling 1l4I26 <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 aftached, and all information contained horein is accurate. <br /> Service Technician Signature Date Total # of Pages <br /> 4 <br /> CERS = California ]Environmental Deporting 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 /> V P H = VacuurnlPressurelHydrostatic <br /> Page 1 of 6 <br />