Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1) <br /> I. FACILITY INFORMATION <br /> Business Name(Same as Facility Name or DBA-Doing Business As) CERS ID <br /> ESTES EXPRESS 10181317 <br /> Business Site Address 0OCKTON <br /> y ZIP Code <br /> 7611 S AIRPORT WAY 95206 <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 /> Amy Winkler <br /> Mailing Address Phone# <br /> 416 2nd Street Galt Ca 95632 (209) 744-0112 <br /> ICC Certification# ICC Certification Expiration Date <br /> 9951552- UC 3/26/2023 <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 /> Date of Assuming <br /> Name of Individual(s)Trained Initial Training Date Responsibility as a <br /> Facility Employee <br /> BILL WARDELL 5/1/2018 5/1/2018 <br /> RYAN OIL 7/10/2016 7/10/2016 <br /> JEREMIAH PHILLIPS 9/1/2016 9/1/2016 <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 4m W1nkla- Date of Training <br /> 5/7/2021 <br /> CERS=California Environmental Reporting System,ID=Identification,ICC=International Code Council,UST=Underground Storage Tank <br />