Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1) <br /> I. FACILITY INFORMATION <br /> Business Name(Same as Facility Name or DBA-Doing Business As.) --FC—ERS ID <br /> TRACY UNIFIED SCHOOL DISTRICT 110181579 <br /> Business Site Address City ZIP Code <br /> 1975 W. LOWELL AVE TRACY 195376 <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training(Print as shown on the/CC Certification) <br /> BRYAN KILBY <br /> Mailing Address Phone# <br /> 2370 MAGGIO CIRCLE #4, LODI, CA 95240 209 367 - 4800 Ext. <br /> ICC Certification# ICC Certification Expiration Date <br /> 9823281 11/16/2022 <br /> III. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing facility <br /> employee duties. Individuals assuming the duties of the facility employee on and after October 13,2018 must be trained before performing <br /> facility employee duties. <br /> Check this box if a list of the individual(s)trained Is appended to this form. The appended list ata minimum must contain al!of the <br /> information in this section. <br /> Initial Training Date Date of Assuming <br /> Name of Individual(s)Trained Responsibility as a <br /> Facility Employee <br /> gyq 04- <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The facility employees listed above have completed the required training in accordance with California Code of Regulations, <br /> "Ile 23, division 3,chapter 1$,section 2715( c)and all the information provide herein is accurate. <br /> Training D ' ateVAT Operator Signature Date of Training <br /> - 2r <br /> CERS=California Environmental Reporting Systems,ID=Identification,ICC=International Code Council,UST=Underground storage tank <br />