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UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1 of 2) <br /> 1 . FACILITY INFORMATION <br /> CERS ID Date of Designated UST Operator Inspection <br /> # 10184725t 08/24/2020 <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 Trac 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 /> 111 . COMPLIANCE ISSUES <br /> All answer of V or "NA " in sections VII through XI must be explained in this section and may require follow-up action. <br /> 1 . All Functions Normal at time of inspection <br /> 2 . Nothing to report this period <br /> 3. <br /> 4. <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 230 <br /> division 3, chapter 16, section 2716 and all the information provided herein is accurate. <br /> Designated UST Operator Signature <br /> V. OWNER / OPtRATOR D.EtCRIPTION OF FOLLOW-UP ACTIONS <br /> A// issue l/stcd in section //1 above, rnust hava a descnpnon 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 M. <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 Sign ure Date Signed <br /> Hakimi Was Manager 08/24/20 <br /> CERS = California Environmental Reporting System. ID = Identification UST = Underground storage tank ICC = International Code Council <br />