Laserfiche WebLink
2320 N. EI Dorado St, Stockton, Ca 95204 <br /> 02/18/2021 Program: UST <br /> PHOTO 1: <br /> Trainin Certification documents initial training dates after the date of assumin responsibility <br /> rACRITY Eort <br /> I :FAGILrry INFoiiN TION - '�CERS ID <br /> Business Name(Same as-WFac�Vjlty AName or DBA-D g B mess As) lO 1 r6 2 t" <br /> E I Do rr—Ao J m- ,, LPcyS2o l <br /> Business Site Address \ City <br /> Z;zV 1J. Cl�jprq�yJ S� TJC.V�J.^� <br /> )! ' UNDERGROUND STbf#�GEE�"GK`c1!IkC'... <br /> Name of Designated UST Operator Providing the Training(Print as shown on the ICC Certiflcaflon j <br /> 1Zober4 <br /> Mailing Address <br /> Phone <br /> 21Z0 0. Et S7oya{yo I. ��uck to ,Ca. g526t1 -69`13-t-tl <br /> ICC Certification# ICC Certification Expiration Date <br /> 52�i05c1� 1-b-2021 <br /> o 'tI�FC$R1YIT <br /> 7110 <br /> Individuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing <br /> facility employee duties.Individuals assuming the duties of the facility employee on and after October 13,2018 must be trained <br /> before performing facility employee duties. <br /> Ej Check this box ff a list of the individuals)trained is appended to this form. The appended list,are minimum,must contain <br /> all of the information in this section. <br /> Date of Assuming <br /> Name.of Individual(s)Trained Initial Training Date Responsibility as a <br /> Facility Employee <br /> dk <br /> ,. <br /> v tcr� w-NA- <br /> I�cw(a. �l'lo+v� sow to- t5-t$ <br /> Ve <br /> l lesh�� tom- ly-'it <br /> oEs - <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 Designefeed U Operator Sig re Date of Training <br /> CELS=Casarlia Bm—ne tal PA)W g*tern,ID=Idertiflra cn,ICC=Irternational Code Could,UST=Underground Storage Talc <br /> VICKY VANG-LEE, EHS Page 1 of 1 <br />