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2701 West March Lane PR0231176 <br /> December 16, 2021 Program: UST <br /> PHOTO 5: Training certificate with initial trainin dates that are incorrect. <br /> S <br /> GOTFPO � <br /> iCEFS <br /> I <br /> JJA� G <br /> UNDERGROUND STORAGE TgNK <br /> FACILITY EMPLOYEE TRAINING CERTIFICgTE(#age t a,1, <br /> uslness Name(sameas Farvllry Name orDeA-om.,l FACILITY INF ORMATION <br /> g easiness As) <br /> 'In <br /> Busl ss Sire gtltlress <br /> IQSIp <br /> Name or Desl II DESIGNATED UNDERGROUND STORAGE TANK OP O zic <br /> gnatep u T overaror Promdmg me Tramin9 lPnnr as snown m ma lcc cadmraeo ERATOR INFORM case <br /> Mauln Ad cess ATION <br /> IC edification# 1'z <br /> ICC Cedlecation Expiration Dale phot,a <br /> 111. FACILITY EMPLOYEE INFORMATION ` <br /> Intlivitluals assuming the tlutlas of the faclli <br /> 11� facility employee dunes.Intlivitluals assumf g the tlutles o/the Oe11�bar 13,2018 must be trained <br /> before performing(acllity employee duties. ty employee on and anaraa a ithi,00 d gado <br /> t berl 2018muat ba tninatl <br /> Cho ck W/s box lfa/1st ofthe intl/vitlua/(s)ha/ned/s <br /> a//of the Mtormar/on/n this section. appsntletl to this form.The appended Ila <br /> n 5� S ata mlmmam,muar coa'.' <br /> Name of Individual(.)Trained <br /> '1 Initial TrTran,,pa,e <br /> Karen Mapp Re^tFcne blllry ase <br /> 1 0/1 612 01 9 Fecllhy EmploYx <br /> Tiffany Fite 1011012018 <br /> Samantha Baxter 1/16/2018 <br /> 111012000 <br /> 8/201a <br /> Jackie NO 1119/2017 <br /> 5/23/2018 <br /> Addison Rhodes 11/2711909 <br /> 3/7/2019 <br /> 317/2019 <br /> L1 81 •i <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The facility employees list ilabove hav completed the required training in accordance with California Code of Regulations, <br /> Title 23,Division ,C apte 16,Section 2 5(c and all the Information provided herein is accurate. <br /> Tr Ig a d S alo gne are ` pate of Training <br /> CERS• ID•Iderftal.,ICC=Irtema6orlel Code Cw-d,UST=Ude1g uilSlaegaTN* <br /> Lydia Baker, SR. REHS Page 5 of 6 <br />