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Apr 18 2018 1435 HP Fax page 3 <br /> UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Pagel of 2) <br /> - 1 . FACILITY INFORMATION <br /> CERS ID Date of Designated UST Operator Inspection <br /> 110182153 12/19/2018 <br /> Business Name (Same as Facility Name or DBA-Doing Business As-) <br /> Lathrop Gas and Food <br /> 4 Business Site Address City ZIP Code <br /> 140 E . Lathrop Road Lathrop 95330 <br /> ESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> 17rint as shown on the /CC Certification.) Phone4i <br /> (925) 389 - 1262 Ext <br /> ICC Certification Expiration Date <br /> 10/01 /2020 <br /> 111 , COMPLIANCE ISSUES <br /> THROP CAS AND FOOD Vll through Xl must be explained in this section and may require follow-up action. <br /> 0 E LATHROP RD <br /> iTFRGP . GA . 95330 <br /> 19 - 982 - 5005 <br /> ;C 19 . 2016 10 : 07 AM <br /> SYt3TEM � ;STATUS REPORT <br /> ALI. FUJCT1UN2 NORMAL <br /> cLARII H 1 STORY REPORT <br /> TION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> SENSOR ALARM - - - - <br /> 1 : :REG ANN d inspection was performed in full compliance with California Code of Regulations, title 23, <br /> : NNUOLAR SPACE kn 2716 and all the information provided herein is accurate. <br /> TENSOR OUT ALARM re <br /> ; Er 1 t : 2018 10 : 19 RM 4ef <br /> = uEL HLF1R1°t OWNER / OPERATOR MESCRIPTION OF FOLLOW -UP ACTIONS <br /> TEC 11 . 2018 10 : 00 AM <br /> must have a description of the follow-up action taken, or to be taken, to correct the issue on the number line that <br /> 3)E NSJR OUT ALARM the compliance issue is listed above in section til. <br /> DEC 11 . 2017 9 : 23 AM <br /> 4 END <br /> 10 . <br /> 19 . <br /> 12 . <br /> VI. OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> I have reviewed section III "COMPLIANCE ISSUES" and provided a description in section V of the action taken or to be taken <br /> to correct the issues discovered . <br /> Name of UST Owner/Operator (Print) UST Owner/01;"r Signa Date Signed <br /> G e - <br /> R e c e 1 v e d T i M e D e c . . 20 . j.201Qqj1 : 10 P M,aN o , 4 5 01 , usT = underww,,� swrcwo tu* cc _ Inwma&nw code co„rrca <br />