Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1) <br /> I. FACILITY INFORMATION <br /> Business Name(Same as Facifrty Name or CBA-Doing Business As.) =CERSIDSinclair <br /> B <br /> City 71P Code usiness site Address I195240 <br /> � Ch�L�lc_ee Lane Lodi <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of❑esignated UST Operatflr Providing the Training {Print as shown on the ICC Certitication.) <br /> Alex A. Jabbari <br /> Phone# <br /> Mailing Address <br /> 537 Amherst CourtSan Ramon, CA 94583 (9251389, - 2E2 Ext- <br /> [CC Certification# ICC Certification Expiration Date <br /> 5243897-UC 912122 <br /> Ili. 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 at a minimum mast contain all 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 /> Rajkamal Atwai <br /> 5110115 5110115 <br /> Gowinder Atwell 5110115 5110115 <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 /> title 23,division 3,chapter 16,section 2715(c)and all the information provide herein is accurate. <br /> Training Designated UST Operator Signature Date of Training <br /> 2116/22 <br /> 1 CERS=California Erwironmental Reporting systems,m=Identification,ICC=International Code Counell,UST=Underground storage tank <br />