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UNDERGROUND STORAGE TANK <br /> E TRAINING CERTIFICATE (Page 1 of 1 ) <br /> FACILITY EMPLOYE <br /> I FACILITY INFORMATION CERS ID <br /> 0 � g 1p� <br /> Business Name (Same as Facility Name or Doing Business As .) Zip Cie <br /> City <br /> BusinessSiteAddtess C ` <br /> gb if 0' Air, <br /> tom++ <br /> I( , DESIGNATED UNDERGROUND STORAGE he icc TANK NIrOPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training (Print as show <br /> Erik Hinojosa Phone tl <br /> Mailing Address 888 500 - CHEK Ext . <br /> PO Box 1394 Lafayette , Ca . 94549 ICC Certification Expiration Date <br /> Icc certification n 06/2912021 <br /> 9209377 <br /> III . FACILITY EMPLOYEE INFORMATION <br /> ined within 30 days of performing facility <br /> Individuals assuming the duties of the facility employee before October , 2018 must be tra <br /> 13 <br /> employee duties. Individuals assuming the duties of the facility employee on and after October 13, 2019 must be trained before poAortnin9 <br /> facility employee duties. <br /> Check this box If list of the Individuals) trolned Is appended to this form. The appended list at a minlmum must contain all of the <br /> Information in this section. Date of Assuming <br /> InAial Training Date Responsibility as a <br /> Name of Individual(s) Trained Facility Employee <br /> v / IV � 1Z � 11s 2ao � <br /> ; n ' i 221 ISIII if I <br /> Z I s 206 <br /> 2Q f is Z ° to <br /> I ME MEN <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 /> title 23 , division 31 chapter 16 , section 2715(c) and all the information provide herein is accurate. <br /> Date of Training <br /> =Trainingated UST Operator Signature — C) <br /> CERs = Caiifomia Environmental Reporting syswms, ID = Identification, ICC = Intemational Code Council, UST = Underground storage tank <br />