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2701 West March Lane PR0231176 <br /> December 16, 2021 Program: UST <br /> PHOTO 3:Training certificate with initial training dates that are incorrect. <br /> 0 �r <br /> COTFA0 S j <br /> CERS 0 ) 1 <br /> UNDERGROUND STORAGE TANK <br /> / FACILITY EMPLOYEE TRAINING CERTIFICATE(sage 1 of 11 <br /> / I. FACILITY INFORMATION <br /> 1 Bualnesa Name(Sarna as diayName or OBA-Doing so-As) <br /> UNOCA76 L CER$ID <br /> Business an.A#dress 10181 <br /> 2701 MARCH LANE city <br /> STOCKTON <br /> 11. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INF 952t9 <br /> Name of 0esgnated UST Operator Providing me Tmining(Pnntes shown on melCC Cer##cee'on.) ORMATIOry <br /> Rita MaNneZ <br /> M.91N Address <br /> 680 Quinn Ave San Jose CA 95112 phone# <br /> ICC CerGlloothm#9028911 ICC Cedificatim Ezpi alion Date (408)971-2445 <br /> Ill. FACILITY EMPLOYEE INFORMATION 12/15/22 <br /> individual'assumingthe tluties of'a facility employee before October 73,2018 <br /> facility employee tluties.Intlividuals assuming the duties of the facility employee nand after Ohad wahin 3�U19 a rmlgg <br /> before performing facility employee duties. otober 13 of Perto <br /> moat be trained <br /> 0 Check this boxifa Nstof the individuals)trained is appended to Mis form.The appentletl list at a minima <br /> ami of the information in this$action. <br /> o I m,musrcontain <br /> Name of Individual($)Trained Initial Training pa% Date of Assuming <br /> ning Resporsalayaea <br /> - Facility Employee <br /> :ert: Tiffany Fite <br /> IR 13/311 w <br /> (1 Karen Montgomery 01/10/08 <br /> _I 03/02/21 09/13h9 <br /> ontainif JacWe Null <br /> 05/25/20 11/27189 <br /> 5 Natalie Vincent <br /> 03102/21 <br /> CDO-- Mariza Ruelas 08/07/19 <br /> 02/03/20 02/03120 <br /> Report <br /> i., <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 Dale of Training 312/21 <br /> CERS=Califomla Environmental Reportiro System,ID=Identification,ICC=International Code Council,UST=Urdergmurd SloagaTank <br /> Lydia Baker, SR. REHS Page 3 of 6 <br />