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AUG/17/2021/TUE 02.23 PM <br />Tracy Truck Stop <br />CERS ID <br />10509463 <br />Business Name (Some as Feclllfy Name or <br />CJS CHEVRON <br />Business Site Address <br />750 W ELEVENTH STREET <br />vrir ainaan.Shhl� mWM�;�t p n <br />,ins sn�ai,vvaia��i^Y <br />�n�a wpzFT�;1FN�M91111' <br />��i <br />Name Of Designated UST Operator (print as shown on <br />David Winkler <br />CCC rf;r^afi^ <br />n � <br />8883059 -UC <br />A1/ answers af'7V"or "NA"in sections <br />1. AST TANKS <br />2. SECTION VIII NO ALARMS <br />3. <br />4. <br />5. <br />6. <br />7. <br />8, <br />9. <br />10. <br />is <br />FAX No,209832 2312 <br />Business As) <br />Certf/ication.) <br />XI must be exp/ainod <br />City <br />TRACY <br />Date of Dasig <br />Phone <br />C®rgflcation <br />suction and may require <br />P, O10 <br />d UST Operator Inspection <br />2019 <br />ZIP Code <br />95304 <br />09) <br />744-0112 <br />2 <br />. <br />action. <br />SITE NOT REQUIRE TO HAVE TANK /LINE/SPILL BUCKET / OVERFILL / . <br />S <br />�SECONDARY TESTING TESTING ASTTTANKS <br />1 hereby cern Pthat the visual inspectlan was performed Ion full compliance with California C ""' ®�d <br />ode of RQgulatiolns, Title 23, <br />blvision 3, Cha ter 16 Sactian 2716 and all th® information rovided herein is accurate. <br />Designated UST Operator Signature <br />A!/issues listed in Section l/1 above must have a description of the fol/ow-up action taken or fo be taken tomcorrect thaUissue onNtheJnumber <br />line that corresponds w)th the number I/ne of fhe compliance issue listed above In Suction 11I. <br />1. <br />2. <br />12. <br />2� <br />I h$ve reviewed Section III "COMPLIANCE ISSUES" and rOVlded a descrl tlOn InY ®�I,1�II�„P•1',�W^'Ik�'�fT^���rGovtrnm�gi�"c'uJl��'?�a��n^j„&;;�j},9 <br />to correct the Issues discovered. iP p Section V of the action taken or to be t$ken <br />NAme of UST Owner/Operator (Print) UST Owner/Operator Signature Date Signed <br />CERS ;4 Califomla Environmental Reporting System, ID = IdandflCation, UST =Underground Storage Tank, ICC = International Code Council <br />Received Time Aug, 11. 2021 3119PM No, 6863 <br />