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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 /> 1. FACILITY INFORMATION <br /> CERS 1D Test Date <br /> 10180717 01/27/2026 <br /> Facility Name <br /> Morada Chevron Fast N Easy#60 <br /> Facility Address City ZIP Code <br /> 108787 N HWY 99 Stockton 95212 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> Elite IV Contractors (209)-461-6337 <br /> Mailing Address <br /> 2535 Wigwam Dr. Stockton, CA. 95205 <br /> Service Technician Performing Testing <br /> Jordan Esqueda <br /> Contractor License Number <br /> 1001331-A <br /> ICC Certification ICC Expiration Date <br /> 10611893 07/21/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> Veeder-Root ATG Technician 09/30/2027 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I 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 /> �A'�gL 01/27/2026 6 <br /> CERS = California Environmental Reporting System, GPH = Gallons Per Hour, ID = Identification, <br /> ICC = 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 />