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10878 North Highway 99 East PR0231598 <br /> April 6, 2022 Program: UST <br /> PHOTO 6: Incomplete Facility Employee Training Certificate. <br /> . w r- <br /> --UERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(page 1 of 1) <br /> Buelness Name(seme sa Fadl Nemo orOBA.Doinga Be`AACILITY INFORMATION <br /> Buelaess Site Addreaa <br /> V �A CERS ID <br /> 7 /•lW Y 9 9 oro• s <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Nemo of DeNgnated UST Operol r ProNtlhlg me I naning 1pdnf ea sMwn on the ICC CanMceflon.) <br /> M8111ng Address _ <br /> Phone# <br /> ICC Cenlrycatlon s <br /> ICC WNgcetlon Explretlon Date <br /> 111. FACILITY EMPLOYEE INFORMATION ' �3 <br /> Individuals assuming the duties of me facility employee before October 13,2018 must be trained within 30 days of performing <br /> botany employee duties,individuals assuming the duties of the facility employee on and after October 13,2018 must be trelned <br /> before performing facility employee duties. <br /> Cl Check drls box lfa list ofthe/ndlvldual(s)haloed is e <br /> all of fhe lydoma J.n In this section. PPended to this form.The appended list,ata minimum,must contain <br /> Name of Individual(s)Trained Data of Assuming <br /> IRIt!I relnl Date Responsibility as s <br /> 1 Facility Employee <br /> 2 <br /> - , Z\ <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> 7hfacility employees listed above have completed the required training In accordance with Callfomia Code of Regulations, <br /> TIU 23,Division 3,Chapter 16,Section 2716(c)and all the Information provided herein is accurate. <br /> Tral Ing Designated UST Oper Sign <br /> Date of Training <br /> e3 A <br /> CER S Catbrrlls Fsdronmental Repodtrg System,ID-kkntlficetint,ICC=IntetrletlonalCode C.ol4UST=Lkx6Ur%M StongeTw1c <br /> Lydia Baker, SR. REHS Page 6 of 6 <br />