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TAN <br /> ,TE (page 1 of 1) <br /> OU:; STORAGE pate <br /> UNDER ININ� CERTIFICA <br /> ITY EMPLOYEE TRATY INFORMATION CERS ID <br /> FA��I. FAC 10181433 ZIP Code <br /> I. ess As) 95219 <br /> Nama or DBA-Doing Bush City <br /> �eSFapliry STOCKTO�R INFORMATION <br /> TANK OPERAT <br /> 5 OUND STORAGE <br /> °SNEUNDERGR Gertiflcation.) <br /> pESIGNATED as shown on the IGG phone# <br /> II' p erator Providing <br /> the Training(Pont (408) 971'2445 <br /> �ar��9pafed UST P <br /> `Bell ICC certification Expiration Date 10/4/25 <br /> `Address 95112 <br /> gpog AVO San Jose CA erforming <br /> adifcation# 8833000 EMPLOYEE INFORMATION of <br /> III FACILITY 2p18 must be trained within 32018 must be trained <br /> ee on and after October 13, <br /> the duties of the facility empl°Yee before October 1 <br /> Individuals assuming ass the Buttes of the facility employ rpust contain <br /> facility employee duties.individuals <br /> duties.ng ended list, at a min►mum, <br /> performing facility emp YThe app <br /> before p P ended to this form. <br /> Date of Assuming <br /> Check this box if a list of the individual(s)trained is a Responsibility as a <br /> all of the information in this section. Initial Training Date Facility Employee <br /> Name of Individuals)Trained 06/28/23 <br /> 11/02/23 <br /> Maxine Sigala <br /> V <br /> )rnia <br /> wider <br /> !d to <br /> ID = <br /> grour <br /> IV. CERTIFICATIONPagf <br /> By DESIGN <br /> The facility employees listed ATED UST <br /> Title 23,Division 3 above have co OPERATOR <br /> Chapter 1G,Section 2715(c)and <br /> t quired CONDUCTING HIS TR <br /> Trainin the re trainin T AINING <br /> g Designated UST lo)and all the i gin ac <br /> �peratoI Signature nforrnation accord With <br /> provided herein is11/2/23 <br /> Califon <br /> accurate. nia C <br /> CERS ode of Regulations <br /> =Calrfonye EnvirorvrrentalReponting SYSem ID- <br /> -Iden Date of Training ' <br /> �afan,ICC=Interratip�l Code Ce�ncii,UST- <br /> Underground Storage Tank <br />