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Appendix XIII <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 1. FACILITY INFORMATION <br /> CERS ID / r InDate <br /> Facility Name 76 March Lane <br /> Facility Address City ZIP Code <br /> 1916 March Lane Stockton 195210 <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator r., Phone <br /> BZ Service Station Maintenance, Inc/�� �� ,� 916-371-2380 <br /> ICC Certification Certification xpir ion Date <br /> 3. COMPLIANCE ISSUES <br /> L eld/'arw► �:�c: l f� �o•✓ b/.�'ne ,rl ' 3/ <br /> f-iGT ✓G �- � ' !-v�G l��/�j�� ��c t�' �� /67 rl %A/ <br /> -L,,,,�;�-- F;�! Sai►-�P <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> I hereby certify that the visual inspection was performed in compliance with California Code <br /> of Regulations, title 23, division 3, chapter 16, section 2716 and all information provided <br /> herein is accurate. <br /> Designated UST 0rator S}onature Date Inspection Report Provided to Owner <br /> --7:)/ <br /> CERS = California Environmental Reporting System, ICC = International Code Council, ID = <br /> Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, UST = Underground <br /> Storage Tank <br /> Page 1 of 4 <br />