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Appenaoc.&ui <br />Underground Storage Tank <br />Designated UST Operator Visual Inspection Report <br />1. FACILITY INFORMATION <br />_ Inspection Date 03!21!22 <br />CERS ID 10182103 <br />Facility Name United 5446 <br />Facility Address <br />1403 Country Club Blvd. <br />2. DESIGNATED UST OPERATOR INFORMATION <br />Name of Designated UST Operator <br />Evangelina Barroso Traylor <br />ICC Certification <br />8200889 <br />3. COMPLIANCE ISSUES <br />City <br />Stockton <br />ZIP Code <br />95204 <br />Phone <br />909 455 2275 <br />Certification Expiration Date <br />2/08123 <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 />De nated UST Operator Signature Date Inspection Report Provided to Owner <br />03/21122 <br />CERS = California Environmental Reporting System, ICC = International Code Council, ID = <br />Identification, NA = Not Applicable, UDC = Under -Dispenser Containment, UST = Underground <br />Storage Tank <br />Page 1 of 4 <br />