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UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1 of 2) <br /> I. FACILITY INFORMATION <br /> CERS ID Date of Designated UST Operator Inspection <br /> 10181455 1/03/20 <br /> Business Name (Same as Facility Name or DBA-Doing Business As.) <br /> 1INF <br /> Business Site Address City ZIP Code <br /> 1990 Piccoli Road Stockton 95215 <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator(Print as shown on the ICC Certification.) Phone# <br /> Erik Brown T(209) 931 - 7438 Ext. <br /> ICC Certification# ICC Certification Expiration Date <br /> 8883731 1/30/20 <br /> Ill. COMPLIANCE ISSUES <br /> All answer of"N"or"NA"in sections Vll through XI must be explained in this section and may require follow-up action. <br /> 1. No leak detection alarms <br /> 2. No leak detection alarms in sump <br /> 3. Tank tightness test not required <br /> 4. Line tightness test not required <br /> r <br /> J. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> 11. <br /> 12. <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> I hereby certify that the visual inspection was performed in full compliance with California Code of Regulations,title 23, <br /> division 3,chapter 16, section 2716 and all the information provided herein is accurate. <br /> Designated UST Operator Signature <br /> V. OWNER/OPERATOR DESCRIPTION OF FOLLOW-UP ACTIONS <br /> All issue listed in section 111 above, must have a description of the follow-up action taken, or to be taken, to correct the issue on the numberline that <br /> corresponds with the number line the compliance issue is listed above in section Ill. <br /> 1. No leak detection alarms, no action needed <br /> 2. No leak detection alarms, no action needed <br /> 3. Tank tightness test not required <br /> 4. Line tightness test not required <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> 11. <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/Operator Signature Date Signed <br /> Erik M. Brown A_ 01/03/20 <br /> (:FRS=(:alifnmia FnwimnmPntal RPnnrtinn-q\/CYPm in=IriPnfifirminn I ICT=I Inr ommi inri ctnranP tank Ir.r=Intamatinnal(.nriP(..ni inril <br />