COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1 ) I . FACILITY INFORMATION Business Name (Same as Facility Name or OBkDoing Business As) CERS ID 7-Eleven 32262 __... _ 101660. 21 Business Site Address City ZIP Code 2360 W. Grant Line Rd . TRACY 11 . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION _ Name of Designated UST Operator Providing the Training (Print as shown on the ICC Certification.) Ismail Taha Mailing Address - - -� -' Phone # 25971 Towne Centre Dr. South�Foothi11 Ranch , CA 92610 (9491460 -5200 ICC Certification tt ( ICC Certification Expiration Date ^_9213648 _ f 611712021 __ -- __ 111 . _ FACILITY EMPLOYEE INFORMATION Individuals assuming the duties of the facility employee before October 13 , 2018 must be trained within 30 days of performing facility employee duties . individuals assuming the duties of the facility employee on and after October 13 , 2018 must be trained before performing facility employee duties . Check this box if a list of the individuals) trained is appended to this form. The appended list, at a minimum, must contain ® all of the information in this section. --- -- — � — -- -- __ _. . - --- - - ---- - - —. Date of Assuming Name of Individual (s) Trained Initial Training Date Responsibility as a Facility Employee See Appended List I IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING — The facility employees listed above have completed the required training in accordance with California Code of Regulations , Title 23 , Division 3 , Chapter 16, Section 2715( c) and all the information provided herein is accurate. Training Designa%o UST Operator Signature � -- Date of Training d CERS = California Environmental Reporting System. ID = Identification, icc = international Code Counai, UST = Underground Storage Tank 7-11 - 32262