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I <br /> Appendix Xiu <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 1. FACILITY INFORMATION <br /> CERS ID10180717 inspection Date 6/21/2021 <br /> Facility Name Chevron <br /> ZIP Code <br /> Facility Address City 95212 <br /> 10878 N Hwy 99 Stockton <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone (916) 704-6948 <br /> Adam Smitheram i <br /> ICC Certification Certification Expiration <br /> ate <br /> 9084899 <br /> 3, COMPLIANCE ISSUES <br /> SO#4583 <br /> Monitor States: ISD vapor leak warning <br /> - Recent liquid alarms are from MIC <br /> Visually inspected for any possible vapor leak areas. <br /> -site changed out some hanging hardware due to drive offs. <br /> - manually cleared ISD alarm <br /> - notified owner if ESD alarms come back to call and notify the office. <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 /> Designat U era Fs' ature Date Inspection Report Provided to Owner <br /> 6/21/2021 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, 1D = <br /> Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, UST= Underground <br /> Storage Tank <br /> Page 'I of 4 <br />