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Appendix 5 <br /> Underground Storage Tank <br /> Release Detection Equipment Testing Report Form <br /> TESTING TYPE n Installation -1 repair �vl 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10166191 02/13/2026 <br /> Facility Name <br /> 7 ELEVEN 35355 <br /> Facility Address City ZIP Cade <br /> 3202 W HAMMER LANE (N-136) STOCKTON 95209 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> Tanknology, Inc. 800-964-1250 <br /> Mailing Address <br /> 11000 N Mopac Expy#500 Austin, Tx 78759 <br /> Service Technician Performing Testing <br /> Jesus Saldivar <br /> Contractor License Number <br /> Class A General Engineering 743160 <br /> ICG Certification ]CC Expiration Date <br /> 8361393 05/12/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> Veeder Root:ATG Technician (1345334) 03/31/2027 <br /> Veeder Root:Red Jacket Mechanical Line Leak Detector(B45334) 08/08/2026 <br /> VMI:TLDT-5000 Tester(3802) 10/24/2027 <br /> OPW:EVR Phase 1 (104302) 01/07/2027 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that all equipment identified in this form has been rested 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 /> 02/13/2026 6 <br /> CERS = California Environmental Reporting System, GPH = Gallons Per Hour, ID = Identification, <br /> ICC = International Caste Council, LLD = Llne Leak Detector, NA = Not Applicable, UDC = Under- <br /> Dispenser Containment, UST = Underground Storage Tank, VPH = Vacuum/Pressure/Hydrostatic <br /> Page 1 of 6 <br />