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1856 West Country Club Blvd. <br />July 26, 2021 <br />PHOTO 1: Amv Winkler not on list of DOS in CERS. <br />Appendix XIII <br />Underground Storage Tank <br />Designated UST Operator Visual Inspection Report <br />t• FACILITY INFORMATION <br />I CERS ID <br />10180831 Inspection Date 6/4121 <br />Facility Name STOP AND SHOP <br />Facility Address 1856 COUNTRY CLUB BLVD city STOCKTON ip Code 95,, <br />2. DESIGNATED UST OPERATOR INFORMATION <br />Name of Designated UST Operator Amy Winkler Phone 209-744-0112 <br />'! ICC Certification 9951352 -UC Certification Exp Date 3/26/2023 <br />3, COMPLIANCE ISSUES <br />"ent/fy by number al/ compliance issues listed <br />a. ctli 1 IFIGATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br />I hereby certify that the visual inspection was performed in compliance with California Code <br />of Reguiations, title 23, division 3, chapter 16, section 2716 and all information provided <br />I <br />is accurate. <br />Date Inspection Report Provided to Owner <br />6-4-21 <br />1EERS = California Environmental Reporting System, ICC = International Code Council, ID = <br />Identification, NA = Not Applicable, UDC = Under -Dispenser Containment, UST = Underground <br />Storage Tank <br />07/26/2021 11�i <br />Page 1 of 4 <br />PR0231069 <br />Program: UST <br />Lydia Baker, SR. REHS Page 1 of 2 <br />