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UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT ( page; <br /> Page 1 of 2) <br /> I . FACILITY INFORMATION <br /> CERS ID Date of Designated UST Operator Inspection <br /> # 10184725t 07/24/2020 <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 Tracy 95304 <br /> II . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Print as shown on the ICC Certification.) Phone # <br /> Rick Branchini ( 925 ) 699 - 1396 Ext. <br /> ICC Certification # ICC Certification Expiration Date <br /> 8164986 06/2/2022 <br /> III . COMPLIANCE ISSUES <br /> All answer of "N" or "NA " in sections Vll through XI must be explained in this section and may require follow-up action. <br /> 1 . All Functions Normal at time of ins ection7/24/20 <br /> 2 . Nothing to report this period <br /> 3 . Q - 1 PLLD Shutdown 7/7/20 NFA <br /> 4 . 0 -2 PLLD Shutdown 7/7/20 NFA <br /> 5. <br /> 6 . <br /> 7 . <br /> 8 . <br /> 9 . <br /> 10 . <br /> 11 . Sections VII thru XLL Continuous in tank leak detection method TLS -350 PLLD line testing See Alarm <br /> 12 . history report . Continuous in tank leak detection & Line tightness PLLD testing continuous <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 /> V. OWNEK / OPERATOR DESCRIPTION OF FOLLOW- UP ACTIONS <br /> All issue listed in section 111 above, must have a description or the foliow-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 111. <br /> 1 . No open issues at thie time of inspection <br /> 2 . <br /> 3 . <br /> 4. <br /> 5 . <br /> 6 . <br /> 7 . <br /> 8 . <br /> 9 . <br /> 10 . <br /> 11 . <br /> 12 . <br /> VI . OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <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 . <br /> Name of UST Owner/Operator (Print) UST Owner/Operator Signatur Date Signed <br /> Hakimi Was Manager 07/24/20 <br /> i <br /> CERS = Califomla Environmental Reporting System , ID = Identification, UST = Underground storage tank [CC = International Code Council <br />