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 /> 7-Eleven 38877 10851091 <br /> Business Site Address City ZIP Code <br /> 1515 East Main Street Stockton 95205 <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 /> Kevin Dutra <br /> Mailing Address Phone# <br /> 25971 Towne Centre Dr. South Foothill Ranch CA 92610 949 460-5200 <br /> ICC Certification# ICC Certification Expiration Date <br /> 9273805 1 7/29/2021 <br /> Ill. 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 /> ail 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 /> See Appended List <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 Date of Training <br /> 05/20/2021 <br /> v <br /> CERS=California Environmental Reporting System,ID=Identification,ICC=International Code Council.UST=Undergo o nd Storage Tank <br /> 7-11 -38877 <br />