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CERS = California Environmental Reporting Systems, ID = Identification, ICC = International Code Council, UST = Underground storage tank UNDERGROUND STORAGE TANK FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1) I. FACILITY INFORMATION Business Name (Same as Facility Name or DBA-Doing Business As.) Sutter Health Tracy Community Hospital CERS ID 10397599 Business Site Address 1420 N. Tracy Blvd. City Tracy ZIP Code 95376 II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION Name of Designated UST Operator Providing the Training (Print as shown on the ICC Certification.) Isaac Anderson Mailing Address P.O. Box 4208 Phone # (209) 532 - 7320 Ext. ICC Certification # 8146912 ICC Certification Expiration Date 09/10/22 III. FACILITY EMPLOYEE INFORMATION Individuals assuming the duties of the facility employee before October 13, 2018 must be trained within 30 days of performing facility employee duties. Individuals assuming the duties of the facility employee on and after October 13, 2018 must be trained before performing facility employee duties. Check this box if a list of the individual(s) trained is appended to this form. The appended list at a minimum must contain all of the information in this section. Name of Individual(s) Trained Initial Training Date Date of Assuming Responsibility as a Facility Employee Jason Simmons 01/14/14 2014 Brent Matteroli 05/07/18 2018 James Rinaldo 02/22/18 2018 Ariana Fregoso 06/05/05 2005 Blair Abrams 03/15/12 2012 Kenny Jones 02/24/20 2020 IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING The facility employees listed above have completed the required training in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2715(c) and all the information provide herein is accurate. Training Designated UST Operator Signature Date of Training 11/18/21