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UNDERG <br /> GETANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERA OR V SUAL INSPECTION REPORT Page 1 of 2) <br /> CERS ID (• FACILITY INFORMATION <br /> Date of Designated UST Operator inspection <br /> 10181487 01 /10/2020 <br /> Business Name (Same as Facility Name or DBA-Doing Business As) <br /> Tesoro , 68153 SP : 4612 <br /> ZIP Code <br /> Business Site Address City 95242 <br /> 2448 W Kettlernan Lane Lodi <br /> 11. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> rName Dasignated UST Operator (Print as shown on the ICC Certification.) Phone #gliareni {949) 460-5200 EEification # ICC Certification Expiration Date3 11 /20/2021 <br /> III. COMPLIANCE ISSUES <br /> All answers of N" or WA " in sections Of through XI must be explained !n this section and may require follow up action. <br /> i . Site has double walled tanks. <br /> ---- — – -- <br /> .—Site lias aotilile walled lines. <br /> iy , CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION inspection was performed in full compliance with California Code of Regulations, Title 23F <br /> 1 hereby certify that the visual <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 /> AN issues listed in Swith a <br /> h th bo tuber line of the complianceissue) listed above in Section ollow-up action taken or tIll. r <br /> o be taken to correct the issue on the number <br /> line that correspond <br /> 1 . No follow-up required. t <br /> 2. No follow-trp required. <br /> IN <br /> VI. OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> i have revle section 111 "COMPLIANCE ISSUES" and provided a description In Section V of the action taken or to be taken <br /> to correct a is as discovered. <br /> Name of US Own perator (Print) UST Owe=Operator S1 nature Date Signed <br /> I ^ � O 'ZU2o <br /> 110 <br /> CEM En*wmerkal RaponlrvSyAM ID = Identi atbn, UST = UrtdeWind Storage Tank, ICC = Ir0tai tatlatai Code Cotard <br />