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Appendix XIII <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 1. FACILITY INFORMATION <br /> CERS ID 10180717 Inspection Date 12/12/2021 <br /> Facility Name Chevron <br /> Facility Address City ZIP Code <br /> 10878 N HWY 99 Stockton 95212 <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone <br /> Adam Smitheram (916)704-6948 <br /> ICC Certification Certification Expiration Date <br /> 9084899 1/22/2023 <br /> 3. COMPLIANCE ISSUES <br /> SO#6772 <br /> Monitor States:All Functions Normal <br /> No recent liquid alarms <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 /> Designat9eqOper or nat Date inspection Report Provided to Owner <br /> 12/12!2021 <br /> CERS=California Environmental Reporting System,ICC=International Code Council, ID= <br /> Idenalge Tank NA=Not Applicable,UDC=Under-Dispenser Containment, UST=Underground <br /> StoPage 1 of 4 <br /> i <br /> 1 <br />