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3807 Coronado Ave, Stockton Ca 95204 Record ID PR0231066 <br /> 10/12/2020 Program: UST <br /> PHOTO 2: <br /> 12/12/2019 Facility Employee Training Certificate <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EM P LOYEE TRAINING CERTIFICATE(page s of 1) <br /> 8ualness Na 1. FACILITY INFORMATION <br /> me(Same as FacAiry or OBA- nq 13usinesa As.) RS ID <br /> Rusin, Atltl ss E Code <br /> NOD <br /> li. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Desi nated LIST Operator Providing the T ining{Pontes shown on the ICC Certification} <br /> r1f J C <br /> Ill gAd sfit w n�� P one# qe <br /> C[} p - C - EA <br /> ICC ertifiratID ` ICC Cer98rati stats pate <br /> III. FACILITY EMPLOYEE INFORMATION <br /> Indhilduals assuming the duties of the facility employee before October 13,2018 must he trained within 30 days of performing tacifity <br /> employee duties, Individuals assuming 1he duties of the facility employee on and after October 13,2018 must be trained before Pelf OMIN <br /> facility employee duties. <br /> Check this box ifa 11st of the 1ndMduai(s)trained is appended to this form. the appended list at a minimum must contain all orthe <br /> informatlon in this section, <br /> Initial 72lning Date Date Of lusuming <br /> Responsibility as a <br /> Name of IndN!duaF(s)Trained Farifty Employee <br /> I . <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 Regulat <br /> 41de 23,division 3,chapter 16,section 2715(c)and all the information provide herein is accurate. <br /> ❑ate of Training <br /> training aced UST Operator son <br /> i <br /> —.WT`=1141—=Fi—Itrimr-mist inT=Ljndernroundstoragetar* <br /> VICKY VANG-LEE, EHS Page 2 of 2 <br />