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Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION IM Installation Ej Repair rl 12 Month <br /> 1. 'FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 12-13-24 <br /> Facility Name <br /> Teichert <br /> Facility Address City ZIP Code <br /> 120 Frank West Circle Stockton 195026 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Armas Engineering Inc (833) 432-1222 <br /> Mailing Address <br /> P.O. Box 1595 Vacaville, CA 95696 <br /> Service Technician Performing Test <br /> Joseph D. Armour <br /> Contractor/Tank Tester License Number <br /> 1054181 <br /> ICC Number ICC Expiration Date <br /> 8153735 12-8-2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root ATG Technician A20282 5-13-2025 <br /> VMI LDT-890 11-25-2026 <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 /> 12-13-24 3 <br /> ,r <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 />