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UNDERGROUND STORAGETANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Pagett 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 /> � ,:si^±ess Si:eAddress City ZIP Code <br /> 140 E . Lathrop Road Lathrop 95330 <br /> SIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> print as shown on the ICC CerbWoation.) Phone # <br /> (925) 389 - 1262 ext. <br /> ICC Certification Expiration Date <br /> 10/01 /2020 <br /> ltl . COMPLIANCE ISSUES <br /> ATH:ROP GAS AND FOOD Vll through X/ must be explained in this section and may require follow-up action. <br /> 40 c LATHROP RD <br /> ATH`ROP , CA . 95330 <br /> ! 09 - 382 - 5005 <br /> IEC 19 . 2018 10 : 07 AM <br /> SY,nT £M ' STATUS REPORT <br /> AL:: FU dCT 1 ONS NORMAL <br /> ALARI°l H I STORY REPORT <br /> TION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> SENSOR ALARM - - - - - <br /> L 1 : REG ANN it inspection was performed in full compliance with California Code of Regulations, title 23, <br /> ANPIU:-AR SPACE n 2716 and all the Information provided herein is accurate. <br /> SENSOR OUT ALARM re <br /> DEC 1 1 ; 2018 10 t 19 AM 7? <br /> FUEL ALARM OWNER ! OPERATOR I ESCRIPT(ON OF FOLLOW-UP ACTIONS <br /> DEC, 11 . 2019 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 /> SEWOR OUT ALARM the compliance issue is listed above in section Ifl. <br /> DEC 11 . 2017 9 : 23 AM <br /> t * x )t END x * h <br /> 10. <br /> 11 . <br /> 12 . <br /> VI. OWNER I OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> I have reviewed section ill "COMPLIANCE ISSUES" and provided a description in section V5 of the action taken or to be taken <br /> to correct the issues discovered. <br /> Name of UST OwnarlOperator (Print) UST Owner/0, r Signa Date Signed <br /> L� 231 S IS v : - ". )2A?P F <br /> L I� <br /> CERS = California Environmental Reporting 4)t§§mr ID = identification, UST = Undermpwrid storage tank. ICC = lnterr►ational Code Coundt <br />