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AUG/17/2021/TUE 02,24 PM Tracy Truck Stop FAX No,209832 2312 P,014
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<br />CERS ID Date of Dasignated'UST Operator Inspection
<br />10509463 10/25/2019
<br />Buslnese Name (Same as Facility Name or DBA -Doing Business As)
<br />CJ CHEVRON
<br />Bueiness Site AddrA68 City ZIP Code
<br />7501 ELEVENTH STREET TRACY 95304
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<br />g Operator (Pnnt as shown on the ICC Cgrtification.J Phone#fi ,.",°°.,,,vda ` x.l^nneolo�®t„�t;'��
<br />Felix Ramirez . (209) 744-0112
<br />ICC Certifleatlon # ICC CenlflC2tlon Expiration Date
<br />8883072 -UC S/1 /2020
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<br />All answers of "N" or "NA"in sections VI/ through X/ must be explained in this section and may require follow-up act/on,
<br />1 ° NO ALARMS
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<br />7. NO SPILL BUCKET TEST NO SPILL BUCKETS
<br />84 NO PLLD TEST NEEDED
<br />9., NO 939 TESTING NEEDEDmallal
<br />10. NO TANK TEST NEEDED ..�..�..�---------,.,._,...,_------•...,.._ .�_..,..�-^...,......�..-..,,�
<br />11. NO LINE TEST NEEDED
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<br />I hereby certify that the visual inspection was pertormed in full compliance with California Code of Regulations, Title 23,
<br />Division 3, Chapter 16, Section 2716 and al! the information provided herein is accurst®.
<br />Designated UST Op®rotor Signatur®
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<br />At! Issues listed in Section "J" above
<br />must have a description of the follow-up ecfion taken orto be taken to correct the issue on the number
<br />line that corresponds with the number line of the compliance issuo listed above in Sect/on
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<br />1 have reviewed Section III "COMPLIANCE ISSUES" and provided a description in Section V of the action taken or to be taken
<br />to correct the Issues discovered.
<br />Nam�Q/Of�UST Owner/Operator (Print) UST OwnerlOper\ator Slgrloture DetA Signed
<br />119
<br />CERS = Califomla Envlr>,nmenial Reporting System, ID = Identficdyon, UST= Undgl jtound Storage Tank, ICC = Intantallonal Cod®.Council
<br />Received Time Aug, 11. 2021 31
<br />19PM No, 6863
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