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200714-618 <br />UNDERGROUND STORAGE TANK <br />DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1 of 2) <br />CERS = California Environmental Reporting System, ID = Identification, UST= Underground Storage Tank, ICC = International Code Council <br />I. FACILITY INFORMATION <br />CERS ID <br />10181481 <br />Date of Designated UST Operator Inspection <br />08/12/20 <br />Business Name (Same as Facility Name or DBA -Doing Business As) <br />Manteca CA FO REGEN <br />Business Site Address <br />2551 E. Louise Ave. <br />City ZIP Code <br />Lathrop 95330 <br />Il. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br />Name of Designated UST Operator (Print as shown on the ICC Certification.) <br />Kraig Kinder <br />Phone # <br />1 (888) 588-8737 <br />ICG Certification # <br />8296393 <br />ICC Certification Expiration Date <br />12/07/20 <br />111. COMPLIANCE ISSUES <br />All answers of "N" or WX in sections Vll through XI must be explained in this section and may require follow-up action. <br />1. N/A Line Tightness Testing- Secondarily Contained and is a Suction System <br />2. N/A Tank Tightness Testing- Secondarily Contained <br />3, N/A UDC- Emergency Generator <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />11. <br />12. <br />IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br />I hereby certify that the visual inspection was performed in full compliance with California Code of Regulations, Title 23, <br />Division 3, Chapter 16, Section 2716 and all the information provided herein is accurate. <br />Designated UST Operator Signature Kralg i<in�PC 1�y$�gmd by K 19 fonder <br />Da(e: 2020,08.1211:113 <br />V. OWNER / OPERATOR DESCRIPTION OF FOLLOW-UP ACTIONS <br />All issues listed in Section 111 above must have a description of the follow-up action taken or to be taken to correct the issue on the number <br />line that corresponds with the number line of the compliance issue listed above in Section Ill. <br />10- <br />22 <br />3. <br />4. <br />5. <br />__7. <br />8. <br />9. <br />10. <br />11. <br />12. <br />VI. OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br />I have reviewed Section III "COMPLIANCE ISSUES" and provided a description in Section V of the action taken or to be taken <br />to correct the issues discovered. <br />Name of UST Owner/Operator (Print) <br />Zachary Feingold <br />UST Owner/Operator Signature <br />Digitally signed by Zachary Feingold <br />Zachary Feingold Date: 2021.04.2812:23:42-0700' <br />Date Signed <br />