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3807 Coronado Ave, Stockton Ca 95204 Record ID PR0231066 <br /> 10/12/2020 Program: UST <br /> PHOTO 1: <br /> 07/22/2020 Facility Employee Training Certificate <br /> UNDERGROUND 570 RAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(Pagel Of') <br /> I- FACILITY INFORMATION cERS ID <br /> Business Neme( as Fedli <br /> moor A-Dofng urine s.Ji ZIP Code <br /> [� City <br /> Business Sfte Ad <br /> !I. DESIGNATED UNDERGROUND <br /> STORAGE TANK OPERATOR INFORMATION <br /> Nam.of Oesigna ST Ope ar Pmvidlrg the Tr' g(Pdnf as shown the ICC CertiNcefion.J <br /> on <br /> Phone# <br /> Madfng Address Ext. <br /> ICC Certification A' / ICC Certification Exp2-ion D --7 <br /> Ill. FACILITY EMPLOYEE INFORMATION <br /> Individuals assumin the duties of the facility employee before October 79,2018 must be trained within 30 days of performing Facility <br /> employee dI Individuals assuming the duties of the facility employee on and after October 13,2018 must be trained before performing <br /> facility employee duties. <br /> check this bozifa list offhe lndWdual(S)fminedls appended to this tone. The appended list at a minfmurO must contain Off ofthe <br /> Information In this seuvon. <br /> Initial Training Date Date of Assuming <br /> Responsibility as a <br /> Name of Individual(s)Yrained Facility Employee <br /> �►•,� 12-2CA'\ -Zd <br /> IV. CERTIFICATION 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 /> -tie 23, 1 ' to ,chapter 16,section 2715(c)and all the information provide herein Is accurate. <br /> fning0 ignated ST Operator Signal <br /> D of Trai <br /> ning <br /> i <br /> Environmenal Re crb, S s' <br /> p 9 Y em_,ID=Inl';plir ' *Mnog=I <br /> - _ a[tal Codc Council,UST=Under[jround story <br /> .. .. _ 9e hank <br /> VICKY VANG-LEE, EHS Page 1 of 2 <br />