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Fr <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1 ) <br /> 1 . FACILITY INFORMATION <br /> Business NaWe .' ade as Facility Name c DBA -Doing Business As) TCERRiS ID <br /> IJC � <br /> Business Site Address City ZIP Code <br /> a <br /> 9529 1 <br /> IL. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training (Print as shown on the ICC Certification.) <br /> i <br /> Dave Winkler <br /> Mailing Address Phone # <br /> 416 2nd Street Galt CA 95632 209 744 -0112 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8883059 - UC 2/23/2020 } <br /> III . FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employee before October 13 , 2018 must be trained within 30 days of performing <br /> facility employee duties . Individuals assuming the duties of the facility employee on and after October 13 , 2018 must be trained <br /> before performing facility employee duties . <br /> Check this box if a list of the individual(s) trained is appended to this form. The appended list, at a minimum, must contain <br /> El all of the information in this section . _„ <br /> Date of Assuming G <br /> Initial Training Date Responsibility as a <br /> Name of Individual (s ) Trained Facility Employee <br /> o nn �- � ,e7 6L c� a <br /> i <br /> 5 <br /> ,I - <br /> IV. CERTIFICATIOh1 BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The facility employees listed above have completed the required training in accordance with California Code of Regulations <br /> Title 23 , Division 3 , Chapter 16 , Section 2715 ( c) and all the information provided herein is accurate . <br /> 7 :71 <br /> Training Designated UST Operator Signature Date olraini <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council, UST = Underground Storage Tank <br />