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�, _— --- <br /> F <br /> UNDERGROUND STORAGE TANK 1 at t) <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (rte <br /> FACILITY INFO_R_M_AT_ION - <br /> -- ---- ----- --- <br /> l _ CERS ID <br /> Business As) 101 92043 <br /> Business Name(Same as Facility Name or DBA-Doing ZIP Code <br /> ST'OCKTOFOOD & GAS city 95206 <br /> Business Site Address rd'TOCKTON <br /> 1605 S EL DORADO ST <br /> it. DESIGNATED UNDERGROUND STORAGE shown on me TAI <br /> OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Trairririg(PTnf a <br /> Cave Winkler Phone# <br /> 209 744-01.12 <br /> Mailing Address ------ - <br /> 416 2nd Street-Galt CA 95632 - --- <br /> __ — ICC CeRiflcatlon Expiration D <br /> ICC Certification# <br /> 8883059=UC ate 2/172022 <br /> FACILITY EMPLOYEE INFORMATION _ —_ <br /> r 13; 2011 must be trained within 30 days of performing <br /> Individuals assuming the duties of the facility employee before Octobe <br /> facility employee duties.Individuals assuming the duties of the facility empl8yee on and after October 13,2018 must be trained <br /> before performing facility employee duties. <br /> 0 Check thls box ffa list of the indlvidual(s)tralned is appended to this form. The appended list,at a minimum, must contain <br /> all of the Information in this section. __ <br /> __ - - - - -- Date of Assuming <br /> initial Training Date Responsibility as a <br /> Name of Individual($)Trained Facility Employee <br /> Y�1 <br /> V\-+f� <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> acillty employees listed above have completed the required training in accordance vitith Califomia Code <br />.S, [N elon 3, Chapter 16, Sectionn le accurate <br /> Z715(c)and all the Information provided herei of Re9ulatil <br /> , <br /> g desgrlated uo I LWrafor Signature <br /> bate of T ininfl <br />