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UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1) <br /> Business Name{same i35 Facility Name or DBA-Doing Busines <br /> FACILITY INFORMATION <br /> Quik Stop Market#124 CERS!D <br /> Business Site Address 10182107 <br /> 505 North Main Street =Ma ZIP Code <br /> ca 9533fi <br /> 1I. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated GST operator Providing the Training(Prinf as shown on tine ICC Certificativrr.} <br /> Anthony Reyes <br /> Mailing Address <br /> P.Q Box1025, est Sacramento, CA, 95591 Phone# <br /> ICC certification ff 91 fi� 372-18$S <br /> 8293772 ICC Certificetfon Expiratlon bate <br /> Ill. FACILITY EMPLOYEE INFORMATION 11/20/2021 <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 13,20 <br /> before performing facility employee duties, 78 must be trained <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 /> Name of Individual(s)Trained bate of Assuming <br /> Initial Training Date Responsibility as a <br /> Satwinder Singh Facility Employee <br /> 10/10/2003 10/10/2003 <br /> Navjot Ka>ar 10/10/2003 10/10/2003 <br /> Gurdeep Singh 6/25/2021 6/25/2021 <br /> FEE E <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 /> Train! g D ignated UST or Signature <br /> Date of Training <br /> 0/25/2021 <br /> CERS=Cagomia Environmental Reporting System,ID=Uentificafion,ICC=International Code Gourd,UST=Unde round Storage Drage Tank <br />