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717 N. Eighth St, Stockton, Ca 95206 <br /> 03/31/2021 Program: UST <br /> PHOTO 1: <br /> Facility Employee Trainin Certificate is missin the designated operator's signature and the date of training <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(Page i of 1) <br /> I. FACILITY INFORMATION <br /> Business Name(Same as Faci ity Neme or DBA-Doing Business As) <br /> S tib L-L CERS ID <br /> Business Site Address <br /> 7(-7 W Cl City ,I I- (d� 8 CR I S <br /> SIOGIC--"�d� aP Code <br /> at DESIGNATED UNDERGROUND STORAGE TANK OPERgTOR J <br /> Name of Designated UST Operator Providing the Training(Print as shown on the icc Certification.) INFORMATION <br /> I�Ou6, N v N N <br /> Mailing Address <br /> 547D JoHNATgA(li DR. AIZIC <br /> N tW 9 4 S6 U Phone# <br /> ICC Certification# ICC Certification Expiration ate <br /> GE2S IoL.hgGfo�1� IGG SZ3�7)6 p <br /> III. FACILITY EMPLOYEE INFORMATION <br /> 11 <br /> 7�0 Z I <br /> Individuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of <br /> facility employee duties.Individuals assuming the duties of the facility employee on and after October 13,2018 must trained <br /> j 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,ata minimum,must contain <br /> all of the information in this section. <br /> Date Of Assumin <br /> Name of Individual(s)Trained Initial Training Date Responsibility as a <br /> Facility Employee <br /> J Of- `D�N(�11ZAt--� 6 16 20 2 0 <br /> sTjFnj 1-v o <br /> 6 16 zr�zo -L C)o <br /> J°S r—C]A <br /> b Ib ZoLo s ( 201 <br /> DRV rp 5F-H;r�� <br /> � W E- Toles slxoMP+loV II /I] Zeno S 3o Zo2o <br /> C4 A 21,1=5 i 1✓tJ A R I I 1 7 20 z o III 2- Z,zo <br /> ✓ �1l I.I w��7Js I I 17 Z vZo I I 15 2-(:32-,o <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 Pratt of Training <br /> CERS=California Environmental Reporting System,ID=Identification,ICC=International Code Council,UST=Underground Storage Tank <br /> VICKY VANG-LEE, EHS Page 1 of 5 <br />