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UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1 of 2) <br /> I . FACILITY INFORMATION <br /> CERS ID Date of Designated UST Operator Inspection <br /> 9/24/20 09/24/2020 <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 I Tracy 195304 <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 E <br /> All answer of "N" or "NA " in sections V11 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. i <br /> 4. <br /> 5 . <br /> 6. t <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 Alarrp <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 4 <br /> division 3, chapter 16, section 2716 and all the information provided herein is accurate. I <br /> Designated UST Operator Signature <br /> � E <br /> V. OWNER / O RATOR ASCRIPTION OF FOLLOW-UP ACTIONS j <br /> All issue listed in section ll/ 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 11. <br /> 7 . 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 S 'gna re Date Signed <br /> Hakimi Was Manager 09/24/20 <br /> CERS = California Environmental Reporting System ID = Identification UST = Underground storage tank ICC = International Code Council <br /> i <br /> j <br />