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3555 W Hammer Ln, Stockton, CA PR0231130 <br /> 04/13/2022 Program: UST <br /> PHOTO 2: <br /> The 07/12/2021 designated operator(DO) inspection was performed more than 30 da s from the previous ins ection <br /> Appendix XIII <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 1. FACILITY INFORMATION Appendix <br /> Underground Storage Tank <br /> CERS IDInspection Date Designated UST O <br /> 10180893 7/1 y2021 <br /> Aerator Visual Inspection Report <br /> Facility Name <br /> Oulck Stop Market#132 1. FACILITY INFORMATION <br /> Facility Address city CERS ID 10180893 <br /> Stockton 195219 <br /> Code <br /> 3555 West Hammer Lane 85218 Facility Name Inspection Date g-11-2021 <br /> 2. DESIGNATED UST OPERATOR INFORMATION Quick Stop Market#132 <br /> Facility Address <br /> Name of DesignaPhone 3555 West Hammer Lane City <br /> Stockton ZIP Code <br /> Curtis <br /> Col. <br /> ar enter ted UST Operator 916-372-1888 <br /> 2. DESIGNATED UST OPERATOR INFORMATION 95219 <br /> ICC Certification Certification Expiration Date Name of Designated UST Operator <br /> 8167865 10/26/2022 Anthony Reyes Phone <br /> 3. COMPLIANCE ISSUES ICC Certification 916-372-1888 <br /> 8293772 —"..'atlon Expiration Date <br /> 11-20-2022 <br /> 3. COMPLIANCE ISSUES <br /> 5 <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION 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 /> tereby certify that the visual inspection was performed in compliance with California Code herein is accurate. <br /> Regulations,title 23,division 3,chapter 16,section 2716 and all information provided Designated UST Operator Signature Date Inspection Report Provided 10 Owner <br /> rein is accurate. <br /> 6-11-2021 <br /> signaled UST Operator Signatuurre CERS=California Environmental Reporting S <br /> moo Date Inspection Report Provided to Owner p 9 Y <br /> (� stem,ICC=International Code Council,ID= <br /> 7/12/2021 Identification,NA=Not Applicable,UDC=Under-Dispenser Containment,UST=Underground <br /> Storage Tank <br /> i=California Environmental Reporting System,ICC=International Code Council,ID= Page t of 4 <br /> 5Cation,NA=Not Applicable,UDC=Under-Dispenser Containment,UST=Underground <br /> le Tank <br /> Page 1 of 4 <br /> VICKY VANG-LEE, REHS Page 2 of 2 <br />