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CERS = California Environmental Reporftrut System, ID = Identification, UST= Underground storage tank, [CC= intern <br />UNDERGROUND STORAGE TANK <br />DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL. INSPECTION REPORT (page 1 of2),- <br />.I. <br />IV FACILITY INFORMATION <br />CERS 10 <br />Date of Designated UST Operator inspection <br />10132636 <br />6-18-2020 <br />Business Name (Same as Facility Name or DBA -Doing Business As.) <br />FLYERS 487 <br />Business Site Address City <br />21P Code <br />983 MOFFAT BLVD IMANTECA <br />95336 <br />II, DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br />Name of Designated UST Operator (Pant as shown on the ICC Certiticatlon) <br />Phone # <br />Clent Gagnier <br />(530) 521 , 6818 Ext. <br />ICC Certification # <br />ICC Certification Expiration Date <br />5243792 <br />9-11-2020 <br />ills COMPLIANCE ISSUES <br />All answer of N" or NA"in sections Vli through Xl must be explained In this section and may require follow-up action. <br />1, Vlik NO SUMP OR LEAK ALARMS- MARKED AS N/A <br />2. <br />3. <br />4, ALL CONTAINMENT CLEAN AND DRY <br />5. <br />6, X- NOT REQUIRED- MARKED AS NIA <br />7. <br />8, X� ANNUAL TESTING DUE IN JUNE <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 233 <br />division 3, chapter 16, section 2716 and all the information provided herein Is accurate, <br />Designated UST Operator Signature <br />V. OWNER I OPERATOR DESCRIPTION OF FOLLOW-UP ACTIONS <br />All Issue listed In section lli above, must have a description of the follow-up action taken, or to be taken, to correct the Issue on the number line that <br />corresponds with the number line the compliance Issue is listed above /n section Ill. <br />2, <br />3. <br />4. <br />5, <br />6, <br />7. <br />9. �nruo� ��'-54�roj Schec�u\eal <br />10, <br />11. <br />12, <br />Vi. OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br />I have reviewed section Ill "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) <br />UST OwnerlOperator Signature Date Signed <br />bft�lad <br />ational Code Council <br />