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m y10Cncn <br /> CD O00cn <br /> m_ � ft 0 <br /> 0 N VI -0 <br /> Q O 0 <br /> 0 d v <br /> .0 0 0 <br /> m v <br /> gTED UND <br /> CO � <br /> DESIGN UNDERGROUND STORAGE TANK � Q- <br /> ERGRDUND <br /> STORAGE LANK pPERgTOR <br /> cERs In VISUAL INSPECTION REPORT(Page 1 of 21 n-r <br /> 1. FACILITY INFORMATION <br /> ��' l7ateGof[5esignated US70perator inspection N <br /> .r 8usinass Name ame as FecilityName or OBA-Oog gusinsyZ m <br /> S CSC 1 <br /> (� Business <br /> site �i <br /> e Address <br /> o I'l �l city �. <br /> c4 It.. v ZIP Code <br /> DES1GNgrFp1UH ROUND STORAGE TANK OPERATOR INFORMATION <br /> Name orpeslgnaed VST Operator P <br /> GREG KA15ER f not as shown on the 1CC Cerification.J <br /> tCc cenikcation# OR STEPHANIE MURPHY Phone# <br /> C'o 5252318(GK), 9383552 S (209)887-2639 P <br /> ..�, ( M} ICC Certification Expiration Date O O <br /> 09/12/2021 (GK), 10/01/2021 (SM) 0 <br /> w J Rltans N"or' 0 <br /> wer Of" NA"In Irr. coIVIpLIANc�lsseJ�s _ <br /> seotlons Vt!through X!must be ex <br /> n O <br /> pR7. 2 plained in this section and may requite follow-up? p action <br /> ,� 3• '� c.1 �' � D <br /> 5. �D <br /> 6. <br /> r. <br /> CD <br /> 0 <br /> 10. � <br /> N <br /> zz <br /> 12. O <br /> IV. <br /> I !he CERTIFICA TICD <br /> hereby certify that <br /> the ON B DESIGNATEp U n <br /> 1 division a vis°af ins 5T OPER4T0 <br /> 3,chapter 76,secti inspect" was performed in full co p R CONpuCT1NG THIS e <br /> Design j ort 27i 6 and alt the i <br /> Aerator si nfo m fiance rNSpEC•r <br /> gnature rmation with C IOly ® '—'• <br /> P, herein afifornia Code ® O <br /> !!. V is accurate. of Regulations,title 23, q � <br /> ;7 Issue listed in section!!/abov, O <br /> OWNER/ R4T a <br /> +i 1 sP°nds with the numberAne the omphance Oe is n'OPERATOR D oSCR�P o1QN OF FOLLOW A O <br /> a <br /> ;} 2" listedaboveinT'eclionhlaken,or to ACT <br /> O <br /> R bo taken,!o correct the S <br /> 3 s <br /> oonthe <br /> numberfine <br /> 4. that <br /> 6. <br /> 7. o' <br /> 9. <br /> 10, A <br /> 12, <br /> ' C CDD <br /> 1 have review Vr. O <br /> t°Corr ect th ed section 111 — /OPS D O <br /> Name <br /> //of/�U57 Wnes Ope atordiscov red pL1AMCF SSUpS l I anaKNOUyLEDGM ' C <br /> 1 ,'/� ((print) provide NT OF <br /> CE q �iloni a G L4 UST ow d a decryption in QM onr VNO t_ISSUES CD <br /> DM'ghma1R rSi tura the actioneke <br /> v s tD,ldeh n or tO be <br /> taken o <br /> ((DD ` UST;tj co <br /> CI rounds to i9ne <br /> v <br /> O ° fan ICC x t 4 Y I <br /> C U <br /> it i - <br /> I I <br />