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Appendix 5 <br /> Underground Storage Tank <br /> Release Detection Equipment Testing Report Form <br /> TESTING TYPE ® Installation ❑ Repair ❑ 12 Month <br /> FCIL ;;:,; <br /> A. [TY lNFQRIii!lATIUN <br /> CERS ID Test Date <br /> 10181441 0611612026 <br /> Facility Name <br /> River Point Landing Maria - Resort <br /> Facility Address City =9Z5219 <br /> 4950 Buckley Cove Way Stockton <br /> ...... .. ............. <br /> ............... ..... <br /> 2: SERV C TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> Elite IV <br /> Contractors (209)_461-6337 <br /> Mailing Address <br /> 2535 Wigwam Dr. Stockton, CA. 95265 <br /> Service Technician Performing Testing <br /> ,Jordan Esqueda <br /> Contractor License Number <br /> 1D91331-A <br /> ICC Certification ]CC Expiration Date <br /> 10611893 07/21/2027 <br /> ffVeed-Root <br /> NG ANj3 CERTlFIICATICNS <br /> .......... ......... . <br /> rer and Test Equipment Training Certifications Training Expiration Date <br /> Tech C36682 09/3012027 <br /> : ERTIFICATII�N E3Y'SO C <br /> ....... .................. <br /> TECHN ;:; : < : ; <br /> IGIAN CC]N[3UCTING;TEST <br /> ....... <br /> l hereby certify that all equipment identified in this form has been tested in accordance with <br /> California Code of Regulations, title 23, division 3, chapter 16, section 2663; that required <br /> supporting documentation is attached;and all information contained herein is accurate. <br /> Service Technician Signature Date Total#of Pages <br /> 04/16/2026 6 <br /> CERS = California Environmental Reporting System, GPH = Gallons Per Hour, ID = Identification, <br /> lCC = international Code Council, LLD = Line Leak Detector, NA = Not Applicable, UDC = Under- <br /> Dispenser Containment, UST = Underground Storage Tank, VPH = Vacuum/Pressure/Hydrostatic <br /> Page 1 of 6 <br />