Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPO, ige I of 2) <br /> I. FACILITY INFORMATION W <br /> CERS ID Date of Designated UST Operator Inspection <br /> 10182043 11/14/2019 <br /> Business Name(Same as Facility Name or DBA-Doing Business As) <br /> Eldorado Market <br /> Business Site Address City ZIP Code <br /> 1605 S EI Dorado St Stockton 95206 <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Naive of Designated UST Operator(Print as shown on the ICC Certification.) Phone# <br /> Karen R Arnaiz (209) 518-4836 <br /> 1CC Certification# iCC Certification Expiration Date <br /> 8030295 2/3/2021 <br /> III. COMPLIANCE ISSUES <br /> A#answers of`N"or NA'in sections Vll through Xl must be explained in this section and may require follow-up action. <br /> 1. VIII NIA: no leak detection alarm occurred, no technician needed to respond. <br /> 2. X NIA: testing not required for this site. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> ,r 12. f <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> 1 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 infprmation provided herein is accurate. <br /> Designated UST Operator Signatu e <br /> - a <br /> V. O NER!OPE TOR DESC TION OF FOLLOW-UP ACTIONS <br /> All issues listed in Section Ill a ove must have a description of the folly ction taken or to be taken to correct the issue on the number <br /> line that corresponds ith the number line of the compliance issue listed abdve in Section!!l. <br /> 1. } <br /> 2. <br /> 3. <br /> 4. <br /> 6. <br /> 7. <br /> 9. <br /> 10. <br /> 11. <br /> 12. <br /> VI. OWNER 1 OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> I have reviewed Section 111 "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! rator S' re Date Signed <br /> CERS=California Enwonmental Reporting System,ID=Identscation,UST=Underground Storage Tank,ICC=International Code Cotudl <br />