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10878 North Highway 99 PR0231598 <br /> May 26, 2021 Program: UST <br /> PHOTO 5: Training certificate missing CERS ID & date of assuming responsibilit . <br /> UNDERGROUND STORAGE TANK toft) <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(page .- <br /> I. FACILITY INFORMATION CERS ID <br /> Business Name(Same as FacilNa a rDBA-Doug Business Asf —PCW /1 <br /> Bene ti w <br /> aro fey e� <br /> It. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated US ding the Training(Pnnt as shown on fhe IGC Certi(rcatlon.) <br /> r �� Phone# <br /> Mailing Address <br /> ICC ICC Cerfificatlan <br /> Ce'Mn pi�ti D <br /> O �C <br /> III. FACILITY EMPLOYEE INFORMATION <br /> facility employee be <br /> Individuals assuming the tluties of the fore 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 /> Ei Check this box fire list of fhe individual(s)hand is appended to this form.The appended list,at a minimum,must contain <br /> al/of the information in this section. <br /> Date of Assuming <br /> Initial Training Date Responsibilityesa <br /> Name of Individuals)Trained Facility Employee <br /> � 23 <br /> IA <br /> I <br /> IV. CERTIFICATION 13Y DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The facility employees listed above have completed the required training in accordance with California <br /> Title 23,Division 3,Chapter 16,Section 2716 c)and all the information provided herein is accurate. Code of Regulations, <br /> ' Training Design US perat r S1 Lure <br /> Date of Training <br /> CERS=CarRariia Bn4ronmeaal Reprxtirg System ID=I �_4 v' <br /> derlOfippa,,ICC=laelnalp,la�Cale Council,UST=U <br /> ^ 9roundStangeTank <br /> Lydia Baker, SR. REHS Page 5 of 8 <br />