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10878 North Highway 99 PR0231598 <br /> May 26, 2021 Program: UST <br /> PHOTO 1: DO re ort missin CERS ID number and owner/o erator name. <br /> O 81G � <br /> ' CE SID NATED UNDERGROUND STORgGD E TTANK <br /> ANK OPERp,7pR VISUAL IN REPORT Pe t as <br /> eu loses Na I' FACILITY INFORMATION <br /> 9a me/a�^ee F 1/ D of Deylynat US DPanrorinvpecnpnt40 <br /> .�,,,. oasesC4 en-tblw euaneaa qr.l ^ lam, <br /> �� ZIPCOEe <br /> m Dealaneeae UST DPo�PNATED UND <br /> ERGROUND STORAGE TANK OPERATOR INFORMATION -' <br /> ICC SMITHER gM ^f as shown on he ICC Ce Mcetbn,) tha6t <br /> 80 c098 Ions Phones <br /> (916)864-2114 E; y of <br /> cc. <br /> 1ra t nnuon F yl a 1^n caro <br /> rarw- ov1ore021 <br /> o <br /> 1• NA•l^aecnwta Vn rnmuBh xi ml� COMPLIANCE ISSUES <br /> 2. Z Plelrretlln sae aecLbn uao M/oawp adbn <br /> 3. 176—y" IZy/yL <br /> 4. <br /> ,. vs <br /> 6• �(rf <br /> 7. 'FA <br /> 9. <br /> 12. <br /> IV. CERTIFICATK)N BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> 1 he by" that the visual Inepectloo was ,J <br /> divl ion 3,she Pedonned In omplian nh Calltom4 Code of Reguletlone,title 23, <br /> pier 78,seetion 2718 a al the IMotmatlon vltletl he b accurate. <br /> Des1 rated UST Operator Sleneture <br /> • WNER/O E R D IPTKUN OF FOLLOW-UP ACTIONS <br /> Allis ue listed fi aedlpn 111 above,must have a deecnpco/fire/dbwup edbn taken,wro ba taken,to corm t the Issue on fire nume6r Ylre met <br /> torte ponds w/fh the number line fha compliance/esus/s 1/atedove abm secv-111. <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 8. <br /> 7. <br /> 9. <br /> 10. <br /> 11. <br /> 12. <br /> VI. OWNER/OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> 4 I hav reviewed section III"COMPLh1NCE ISSUES"and provided a ausalption In section V,of the action taken or to betaken <br /> to co rect the Issues dlacowred. i razor sl nmure <br /> Name of UST Ower/OPeroror(") usr D Siq <br /> - ICC=Intrnalkaaanwfs..m..a <br /> Lydia Baker, SR. REHS Page 1 of 8 <br />