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Quik Stop Market#124, 505 N Main St, Manteca, CA 95336 Record ID PR0231442 <br /> 6/9/2021 <br /> PHOTO# 1 <br /> Facility Employee Certificate incorrectly filled out. Initial Training Date has the date of the training. Employee first and last names were not listed. <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE{page 1 of 1} <br /> business <br /> I. FACILITY INFORMATION . <br /> Name(Same es Facility Nameor CBA-Doing easiness As) CERS In <br /> Quick Stop Market 17,q oI$Zlo—! <br /> susiness site Address <br /> �OS City ZIPCade <br /> Nt vrn) Sr A"' Tcc'� S33(o <br /> It. DESIGNATHD UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Neme o,pesignaled UST Operator ProvltlF. ing the Training(Print as shown on the 1CC Cen+awtbn) I <br /> Harold Largo Jr <br /> Mailing Atltlress Phone/ <br /> 3900 Cotnrnerce Wa <br /> ICC Gertificetion# <br /> ICC Cenifimtlon Ezpiralion Cate <br /> 8293993 9/30/2020 <br /> III, FACILITY EMPLOYEE INFORMATION <br /> I Individuals assuming the duties of the facility employee before October 13,2016 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 he trained <br /> before performing facility employee duties. <br /> Check this box if a fist of the Indlviduarts)trained is appended to this form.The appended list,ata minimum,must contain <br /> all of the Information In this section. <br /> Date of Assuming <br /> Name of Individuagsy Trained Initial Training Date Responsibility as a <br /> Facility Employes - <br /> lub� <br /> ucoT <br /> I <br /> I - I <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(cf and all the Information provided heroin Is accurate. — <br /> Date of Training — <br /> TraiNngDesignated UST Operabrsignature /Q �u <br /> lCoJo CoundI.UST=UMe'r-m Sloraoe Tad, <br /> CERS=Caftunla ErnAornpntal Repolim3 System,ID= cam,ICG <br /> Carol Presto, EHS Page 1 of 1 <br />