Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1) <br /> I. FACILITY INFORMATION <br /> Business N e (Same as Facility Name or DBA-Doing Business As) CERS ID <br /> 1A t CSC j�: MAo 3ct I C) <br /> Business Site Address City ZIP Code <br /> I's cer>v 1 S2.65 <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training (Print as shown on the ICC Certification.) <br /> Harold Largo Jr phone# <br /> Mailing Address <br /> 3900 Commerce Drive, West Sacramento, CA 95691 916-372-1888 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8293993 9/30/2020 <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 /> Check this box if 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 /> Assuming <br /> Name of Individual(s) Trained Initial Training Date Responsibility as a <br /> Facility Employee <br /> �t w <br /> v9 6 . 745 - 1( <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 /> ' 49 Training Designated UST Operator Signature —) <br /> Date of Training <br /> CERS=California Environmental Reporting System, ID=Identification,ICC=Inter nal,UST=Underground Storage Tank <br /> 1 <br />