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Appendix XIII <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 11. FACILITY INFORMATION <br /> CERS ID 10182093 [Inspection Date 05/19/22 <br /> Facility Name RAZI PEROLEUM <br /> Facility Address 950 W 11TH STREET �"" TRACY s51376ode <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> jI <br /> z <br /> Designated UST Operator Phone <br /> kler 209-744-0112 <br /> fication Certification Expiration Date <br /> C 2/17/2024 <br /> [T37�COMPLIANCE ISSUES <br /> Identify by number all compliance issues listed <br /> L y `BSc, 'OM SNC)I. rL/CA IMAM -► <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> I hereby certify that the visual inspection was performed in co <br /> of Regulations, title 23, division 3, chapter 16, section 2716 and <br /> with C Code <br /> herein is accurate. d all informationalifornia <br /> provided <br /> Desiqnated UST Operator Signature <br /> Date Inspection Report Provided to <br /> ERS = California Environmental Re 05/19/22 Owner <br /> pp porting System, ICC = International Code Council, <br /> f�dentification, NA= Not Applicable, UDC = Under-Dispenser Containment, ncil, ID <br /> 'Storage Tank <br /> UST = Underground <br /> Page 1 of 4 <br /> i / <br /> 0 <br />