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2701 West March Lane PR0231176 <br /> December 16, 2021 Program: UST <br /> PHOTO 1: Training certificate with initial training dates that are incorrect. <br /> P _yip z <br /> aw Phone <br /> irrienlal Contact S C C <br /> Email/I77(O <br /> rn I anQ 710 Ci FAO <br /> CERS D / f� <br /> �1 PR <br /> a Tech: Cr <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(page 10,1) <br /> FACILITY INFORMATION <br /> Business Name(Same as Fad&,Name or DBA-Doing Busness As) CERS ID <br /> UNOCAL 76 10181433 <br /> hated O Business site Address City 21p Code <br /> 2701 MARCH LANE STOCKTON 95219 <br /> if. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> REV IE Name of Designated UST Operator Providing the Training(pdnt,,sh,m on the ICC Certlficalion.) <br /> Rita Martinez <br /> Ice Si Ma"ing Address Phone# <br /> 680 Quinn Ave San Jose CA 95112 (408)971-2445 <br /> ICC Cenlncation# ICC Cedlfption Expiration Date <br /> � 9028811 12/15/22 <br /> III. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing <br /> facility employee duties.Individuals assuming the duties of the facility employee on and after October 13,2018 must be trained <br /> before performing facility employee duties. <br /> E] Check this bozff a list of the individual(s)trained 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 /> Name of Individualist Trained Initial Training Date Responsibility as <br /> Facility Employee <br /> Er Tiffany Fite 03/31/21 01/10/08 <br /> N Karen Montgomery 03/02121 09/13/19 <br /> 1 <br /> r Jackie Null 05/25/21 11/27/89 <br /> Natalle Vincent 03/02/21 08/07/19 <br /> / Bianca Hubbard 11/10/21 11/10/21 <br /> V <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 3,Chapter 16,Section 2715(c)and all the information provided herein is accurate. <br /> Training Designated UST Operator Signature /)l _ .,F� Date of Training(IyY,�/_dJ'/b'�.(�G\. 1.1110121 <br /> CERS=California Environmental Reporting System,ID=Idenfilicatbn,ICC=International Code Counct,US - 11 • <br /> • <br /> Lydia Baker, SR. REHS Page 1 of 6 <br />