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UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1 of 2) <br /> I . FACILITY INFORMATION <br /> CERS ID Date of Designated UST Operator Inspection <br /> 10184253 4/ 15/2019 <br /> Business Name (Same as Facility Name or DBA-Doing Business As) <br /> PACIFIC FUEL & AUTO <br /> Business Site Address City ZIP Code <br /> 3304 W. HAMMER LANE STOCKTON 95207 <br /> II . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Print as shown on the ICC Certification. ) Phone # <br /> Zane Nimmo (209 ) 744-0112 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8883064 - UC 2 /25/2020 <br /> III . COMPLIANCE ISSUES <br /> All answers of "N" or "NA " in sections VIl through XI must be explained in this section and may require follow-up action. <br /> 1 . Section VIII - NO ALARMS ! ! ! ! ! ! ! <br /> 20 <br /> 30 <br /> 4. — -- -- -- -- <br /> - -5. — — -- - - - --- <br /> 60 <br /> - - <br /> 70 <br /> 9 . _ <br /> 10 . <br /> lip <br /> 12. Section X - DOUBLEWALL TANKS AND LINES NO TESTING REQUIRED <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 111 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 111. <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 Date Signed <br /> CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council <br />