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Appendix5 <br /> Underground Storage Tank <br /> Release Detection Equipment Testing Report Form <br /> TESTING TYPE ❑ Installation ❑ Repair X 12 Month <br /> 1. FACILITY INFORMATION <br /> CERSID Test Date <br /> 10181463 2/24/2026 <br /> Facility Name <br /> Village West Marina <br /> Facility Address City ZIP Code <br /> 6649 Embarcadero Drive Stockton 95219 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> Diamond Petroleum Services, Inc. (925) 470-0803 <br /> Mailing Address <br /> 3619 King Ct Antioch, CA 94509 <br /> Service Technician Performing Testing <br /> Guadalupe Sanchez <br /> Contractor License Number <br /> 1005444 <br /> ICC Certification ICC Expiration Date <br /> 5250461 3/22/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> eeder Root ATG Technician 4A30I38 9/15/2027 <br /> VMI Vaporless LDT-890 Tester 9 4068 6/24/2027 <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 Reguiations, title 23, division 3, chapter 16, section 2663; that required <br /> supporting documentation is attached;and all information contained herein is accurate. <br /> Service Techni an Signature Date 2I2412026 Total# of Pages <br /> CERS = California Environmental l4eporting 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 />