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Jun 02 20 , 03 :02p p • 9 <br /> FI UNDERGFt011ND STORAGE TANFC <br /> DESI�,'NAT Q:,.1INDERGROUND' STOk A GE TA1�iK 4PERATQR:�/ISl1AL` 11�ISPECTIt N. . REPORT - Pa a 4 ;of 2 <br /> _, . . _ <br /> ' A IF : 1. FACILITY INFORMATION t I I .. <br /> CERS ID Date of Designated UST Operator Inspection <br /> 101812378 4/ 15/2020 <br /> Business Name (Same as Facility Name or DBA-Doing Business As) <br /> WOODBRIDGE ARCO <br /> Business Site Address City ZIP Code <br /> 18808 LOWER SACRAMENTO RD OODBRiDGE 95258 <br /> _ . . .. . <br /> ,1I DESICNA7D t3N ]ERGROEJfUD STORAi3E 'fANK.'4PERATfJR .INFCiFtNtATtON 4. <br /> Name or Designated UST Operator (Print as shown on the ICC Certifloation.) Phone # <br /> David Winkler (209( 7440112 <br /> ICC Certification # ICG Certification Expiration Date <br /> 8883059- UC 2/17/2022 <br /> _ . . . <br /> : . . <br /> Ili CaMPLIANCE ISSUES <br /> FN F <br /> - . <br /> All answers of N' or NA ' in sections Vli through X1 must be explained in this section and may require follow-up action. <br /> 1 . no alarms <br /> 23 F <br /> F - KIM <br /> 44 <br /> 56 <br /> 7,.. _ MAI <br /> 9. <br /> i 10. <br /> 12. section x IF .no tank or line testing needed <br /> . . _ . . F4 <br /> IV : II = : GERTIEICATIQW: BY DESIGNATE17FIL #3S? OFERe4TdR ONDCICTIN :T#iIS.. INSPEGTIQN °- <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 [ S� <br /> V OV1tN ER 1; C}PEIZATOR DESCRIPTION OF FOLLOW=t]R AGS IONS <br /> All issues 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 number <br /> fine that corresponds with the number line of the compliance issue listed above in Section 111. <br /> 1 . <br /> I, 2. <br /> 30 <br /> 60 <br /> 5. <br /> 7. <br /> - 11 .. . <br /> 12 <br /> I IF IF 1, FF; ©WNER � ©PERATOR: AGI{NOW --EDGMEN(TOF :C.OMPI:IANCE:ISSIJES . . .. FF <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. FF FFF,F <br /> Name of UST OwnerlOperetor (Print) UST Ow ed0 ator SI ature Date Signed <br /> IF I <br /> � �. ��•--2c:IZ� <br /> CERS = Cai' Environmeniel Reporting System, lD = IdenttfimGcn, UST = Un 5 e Tank, lCC = tr national Code Couno1 <br /> I <br />