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AUG/17/2021/TUE 02:22 PM Tracy Truck Stop FAX No,209832 2312 P1008 <br />Ed; [NO ID <br />10509463 <br />Business Name (Same as f=acility Name or <br />CJ CHEVRON <br />Buslness Site Address <br />7501 ELEVENTH STREET <br />ame of Designated UST Operator (Print as shown on <br />Felix Ramirez <br />ICC Certification # <br />8883072 -UC <br />°1�m ^��u'Ga��felN. rn"IneidmS�1' Pr �m�m ��ci+�m 0� an�'n�°�,r+w . <br />�tlm.f�Pu� '�P�n nmlAAlm i "udlw '"w aPiPur <br />11Fl u�mifli9TIR�PIq Alinn 14u P Jm Niuvifq 'P ` ,IlxiMR Rin P'%A ��iN4�nlli 9v.9 <br />I�n�+flo PPI q�n1V��'�Fi l� d s�A�+l A�AIiPI.��iVl IM'ilSuiJi�Jl _.�!...IAi4.n <br />II m''�il 91P J' '�dMl t,- SIA IOJM..WIf. ,u <br />All answers of ON" or "AIA in sections Vl/ through <br />V. <br />6. <br />7. .� <br />8. NO PLLD TEST NEEDED <br />9. NO 989 TESTING NEEDED <br />10. NO TANK TEST NEEDED <br />11. NO LINE TEST NEEDED <br />Buslness As) <br />must be explalt7ed in <br />Date of <br />ed.US I Operator Inspection <br />5/10/2019 <br />Oity ZIP Cod <br />TRACY 95304 <br />section and may <br />Phone # <br />(209) 744-0112 <br />n Expiration Date <br />3/1/2020 <br />I�IIiPt°in�.r.��Nl <br />VPilhi4{n°lili R� N 110414O1�Gli I lei/ii1,5nm I I rj Ai'lill[ia�t?II <br />il°Iw HiRuin.l IlHln1Rlnini.°ulli+Is�n P IlulfiNNl,i,lin P� <br />n,!l'..°dnm°1.i�qI���l."�°.r',°12�I"n <br />'ire follow-up action. <br />gemr,M,<re .wfmnwl lFnru^^g,<"'� SIR wo�auiaiu'a,., ;,m.Pr�l°= <br />hereby certify that the visual inspection was performed in full compliance with California Coda of Regulations, Title 23, <br />Division 3, Chapter 16, Section 2716 and all the information provided herein is accurate. <br />f?eaignated UST Operator Signature <br />il �(;17> <br />liner that correspondsowlfh the number I/ne of the om I �anco �ssue IJsiedup action taken or fo�be faken fo correctwthe issue on fnheMrru,m��hyN <br />spm n.I "!C,mu R�.F+,ul .nnlnnlnr <br />mbar <br />p <br />1w above ection M. <br />orrecttthe issuestldiscloverOd.PLIANCE ISSUES" and provided a descriptijllP�.�;�,n�I,�P ^„,.�o�m "''�'r��,-,w.. I^��Pt�sN:'��i�l'n�y�un��rn�'ul�ru��°i�"a�;9'4�1 <br />on in Section V of the action taken or to be taken <br />(QST Own <br />e <br />lr/Operator Signature <br />40 L- . J a.l - <br />Date Signed <br />i(—.ice <br />CERS = Cellferpls EnNronmental Reporting System, ID = Identfflc�tion, UST =Underground Storage Tank, ICC = Intematlonal Code Council <br />Received Time Aug, 11. 2021 3:19PM No, 6863 <br />