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UG010 <br /> UNDERGROUND STORAGE TANK <br /> FDESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 'I of 2) <br /> I . FACILITY INFORMATION <br /> D Date of Designated UST Operator Inspection <br /> 10181541 01 /09/2019 <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 /> I1 . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Print as shown on the ICC Certification) Phone # <br /> Catherine Fowler (760) 995-6898 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8339126 2/23/2019 <br /> III . COMPLIANCE ISSUES ❑ Check If Action Item(s) Are Present <br /> All answers of W)I or "NA " in sections Vll through XI 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 --No alarms have occurred since last month 's inspection . 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 /> 6,6l n 7aatem <br /> V. OWNER / OPERATOR DESCRIPTION OF FOLLOW-UP ACTIONS <br /> All issues listed in Section /// 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 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 Signature DaSig <br /> te ned <br /> Digitally signed bMet Ye <br /> Ariel Yeh Date: 2019.01 . 10Y1511 :20h06'00' <br /> CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council <br />