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UNDERGROUND STORAGE TANK <br /> FDESIGNAT;ED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1 of 2) <br /> 14 FACILITY INFORMATION <br /> D Date of Designated UST Operator Inspection <br /> 725 01 / 17/ 19 <br /> Business Name (Same as Facility Name or DBA-Doing Business As.) <br /> West Valley Auto Service LLC <br /> Business Site Address City ZIP Code <br /> 2615 W Grant Line RD Trac 95304 <br /> I1 . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Print as shown on the /CC Certification.) Phone # <br /> Rick Branchini (925) 699 - 1396 Ext. <br /> ICC Certification # ICC Certification Expiration Date <br /> 5241043-UC NJ 06/19/2020 <br /> III , COMPLIANCE ISSUES <br /> All answer of "W or "NA " In sections Vil through Xl must be explained in this section and may require fallow-up action. <br /> 1 . All Functions Normal at time of inspection <br /> 2 . L-9 Vent sensor 1 / 16 , 1 / 17/ 19 <br /> 3 , E- 1 Com Alarm 1 / 10 , 1 / 14 <br /> 4. ISD 1 /23/18 <br /> 5 . Water in fill sump due to excessive rain <br /> 6 . Repaired failed secondary test UDC 9/ 10- 11 /12 see agency inspection report <br /> 7 . Water removed from Vent containment due to excessive rain <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 /> � 82arzcfir.� <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 number line that <br /> corresponds with the number line the compliance issue is listed above in section Ill. <br /> 1 . Overfill Protection performed by Confidence UST 12/28/18 cerified see report <br /> 2 . <br /> 3 . Failure penetration 1 /2 needs repair and retest Confidence UST to schedule services <br /> 4. <br /> 5 . <br /> 6 . <br /> 7 . <br /> 8 . <br /> 9 . <br /> 10. <br /> 11 . <br /> 12 . <br /> VL OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> 1 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 OwnedOperator Signature Date Signed <br /> Hakimi Was Manager 01 ! 16/ 19 <br /> CERS = California Environmental R n System to Identification, UST = Underground storage tanICC International Code Council <br />