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00010 <br /> UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION ;REPO;RTPage t of 2) <br /> I . FACILITY INFORMATION <br /> CERS ID Date of Designated UST Operator Inspection <br /> 10181541 02/6/2019 <br /> Business Name (Same as Facility Name or DBA-Doing Business As) <br /> Pacific Bell Telephone Co . dba AT&T California <br /> Business Site Address City ZIP Code <br /> 1812 Coley Ave. Escalon 95320 <br /> II . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Print as shown on the ICC Certification.) Phone # <br /> Catherine Fowler 7609956898 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8339126 12/23/2019 <br /> III . COMPLIANCE ISSUES ❑ Check If Action Items) Are Present <br /> All answers of N" or NA " in sections V/l through X/ must be explained in this section and may require follow-up action. <br /> 1 , VII--There were no issues to follow-up on since the last inspection . No response required . <br /> 2 . VIII --AII alarms due to Monitor Certification Testing by TAIT on 1 /22/19. See attached . No follow-ups required . <br /> 3. X--Tank Tightness and Line Tightness Testing are not required at this location . <br /> 4. <br /> 5. <br /> 6. <br /> 7. <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 /> V. OWNER / OPERATOR DESCRIPTION OF FOLLOW-UP ACTIONS <br /> All issues 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 <br /> line that corresponds with the number line of the compliance issue listed above in Section lll. <br /> 1 . <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 111 "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 Signature Date Signed <br /> 7 <br /> CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council <br />