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Appendix 5 <br />Underground Storage Tans <br />Release Detection Equipment Testing Report Farm <br />TESTING TYPE ❑ Installation ❑ Repair V 12 Month <br />1. FACILITY INFORMATION <br />Company Performing Testing <br />CERS ID <br />Tanknology, Inc. <br />Test Date <br />10184539 <br />11000 N Mopac Expy #500 Austin, Tx 78759 <br />01/07/2026 <br />Facility Name <br />Contractor License Number <br />CHEVRON 210997 (N-4693) <br />ICC Certification <br />Facility Address <br />City <br />ZIP Code <br />1442A W COLONY DR. <br />RIPON <br />95366 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing Testing <br />Phone <br />Tanknology, Inc. <br />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 />ICC Certification <br />ICC Expiration Date <br />8361393 <br />05/12/2027 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Veeder Root:ATG Technician (845334) <br />Training Expiration Date <br />03/31/2027 <br />VMI:TLDT-5000 Tester (3802) <br />10/24/2027 <br />OPW:EVR Phase 1 (104302) <br />01/07/2027 <br />14. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST I <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 />1�1_ 01/07/2026 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 />