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AUG/17/2021/TUE 02;21 PM <br />Tracy Truck Stop <br />CERS 1D �` <br />10509463 <br />Business Name (Same $s Facility Name or <br />CJS CHEVRON <br />Buslness SRe Addr®ss <br />750 W ELEVENTH STREET <br />%Y <br />oo:,,.,,:.. �: �:H:ar <br />1nP':.bnwi"�Ia:maiaiSlmn nn"niai .nvv,�:mP, nrv:m ,�..• <br />mr 4° ", I l;lM <br />Name of Designated UST Operator (Print as shown on <br />David Winkler <br />1CC Certrficatlon # <br />8883059 -UC <br />All answers of'N"or'NA"!n sect/ons Vll <br />_AST TANKS <br />2__ SECTION VIII NO ALARMS <br />3, <br />56 <br />Buslness <br />/CC <br />must be <br />FAX No,209832 2312 <br />of Designated UST Operator Inspectlon <br />3/11/2019 <br />95304 <br />ZIP Code <br />Phone � <br />(209) 744-0112 <br />n Expiration Date <br />2/23/2020 <br />section and may require follow-up action. <br />�_........ .�.-_ <br />12. <br />S,F::n I:nJT!:maEyAr:R:iNOTl��Iu.n:REQUIRED <br />EQUIRED.�^D_cTO fViHAVE <br />TANK <br />t�/LINE/SPILL <br />LIE/SPIL <br />..B�m�r U�C�K�rE�.T/-O.��V�ERL�-� <br />--S- E�C-O--N-DAR--- <br />Y�- 'TES—TIN"CAST <br />S` <br />her <br />D vision 3, Cha ter 16hSectionl2716 and all he information I ProvidedhereinIs aceurate1ifornia gar aFP m„ <br />!�nnwp i Mm�::B: v rlmo nu .•n:4 <br />P P P Code of Re ulatlons, Tltfa 23, <br />P p <br />Designated UST Operator Signatures C1 l <br />kn'rthat corrr spondscwlth the numb�rl/ne ofthe� om �ernca issue /Jsted above,h'Sectlon <br />follow-up actJon Taken or to ase taken to correct the issue on <br />2. <br />3. <br />4. <br />5. <br />6. <br />to correctrthe Issues dlsciovered PLIANCE ISSUES" and provided aMdescription In"Section V of the'act1lon takenJor4tonbe taken <br />nawrdein imaihm i <br />Name of UST Owner/Opeor (Pr1nt UST Owner/ Aerator Signature Data Signed <br />OGII�/1:,r'� It l I '?� I q <br />CEPS c Celfixnla Environmental Repotting System, ID =Identification, UST= Underc�round Storage Tank, ICC = Intematlonal Code Counal <br />Received Time Aug, 11. 2021 3:19PM No, 6863 <br />