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EHD Received via Email: <br /> 8/4/2022 <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(Pace 1 or 1) <br /> 1. FACILITY INFORMATION <br /> Business liante Sena as Fac#Hy Name or DBA-Doing 8wb:ess As) P10180797 <br /> ERS IO <br /> Quik Sto 9 <br /> Business Site Address City ZIP Code <br /> 2285 E.Fremont St. Stockton 95205 <br /> 11. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Meme at Designated UST Operator Provift Ike Training(Privl as shown on the ICC CediGa 1kA) <br /> Juan Jauregui <br /> Px1Phone 025 (96)372-1888 <br /> ICC catmeaft P ICC Certifccatch Expiration Date <br /> 8473759 8/5/2023 <br /> III. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employee before October 13,2018 must be trained withln 30 days of performing <br /> facilityemployee duties.individuals assuming the duties of the facility employee on and after October 13,2018 must be trained <br /> before performing facility employee duties. <br /> ® Check this boxNa list ofthe IndMduai(s)trained Is appended to this form. The appended list,at a minimum,must contain <br /> all of the Information/n this section. <br /> Date of Assuming <br /> Name of Individual(s)Trained Initial Training Date Responsibility as a <br /> Fadlily Employee <br /> r <br /> -I jai <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 /> L- Title 23,Division 3,Chapter 18,Section 2715(e)and all the Information provided herein Is accurate. <br /> Training D wm5muzooneture Date of Training 8/13/2029 <br /> r , :;• <br /> CTAS=cIftWfa Systsrtr,(D� ,ICC a WWra onel CadeCawral.USr a Ur dergand Storage Tsrdt <br />