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F- <br /> OUND STORAc'TIF LATE (Page TAN1 of 1) <br /> UNpER F-TRAINING CER <br /> EMPLOYEE TRA TION CERS ID <br /> FACILITY FACILITY INFORMA 10181433 ZIP Code <br /> I. 95219 <br /> Name or DBA.Doi09 Business As) City <br /> Business Nam <br /> e Same as Facility Nam STO KION Z INFORMATION <br /> UNOCAL76 GE TANK OP <br /> Business Site Address IN <br /> gTORA Certification.) <br /> 2701 MARCH SNE on the ICC <br /> ►► I sl NATER print as shown phone# <br /> Hated UST Operator Providing <br /> the Training( (408) 971.2445 <br /> Name of Desig <br /> ha McMahan n Date <br /> Samantha Expiration Mailing Address ICC Certification p 2/27/25 <br /> 680 Quinn Ave San Jose CA 95112 <br /> It Cetificatlon# 8950093 sof performing <br /> III. FACILITY EMPLOYEE INFORMATION <br /> on and after October 13, 2018 must be trained <br /> facility employee before October 13,2018 <br /> must be trained within 30 day <br /> Individuals assuming the duties of the Iur the duties of the facility employee <br /> facitity employee duties.individuals dot es ing <br /> before performing facility employeeended list, at a minimum,must contain <br /> Thea p <br /> Check this box if a list of the individual(s)trained is appended to this form. P <br /> all of the information in this section. Date of Assuming <br /> Initial Training Date Responsibility as a <br /> Name of Individual(s)Trained Facility Employee <br /> 06/14/23 09/13/19 <br /> Karen Montgomery <br /> RAJVEER SINGH 06/14/23 06/14/23 <br /> i <br /> ----------- <br /> I <br /> i <br /> I <br /> I <br /> lV• CERTIFICATION BY DESIGNATED U <br /> The facility employees listed above have co ST OPERATOR <br /> Title 23,Division 3 ! <br /> Chapter 16,Section mpleted the req trainin CONDUCTING THIS TR <br /> Training2715(c)and all the info ed AINING <br /> Designated UST Operator Signature oration g to accords <br /> provided <br /> herein acth atlefornia Code of Re <br /> I <br /> gulations, <br /> CERS=California Environmental Re C <br /> Porti S date of Training <br /> n9 Ystem,ID=Identification,ICC=International Code Council,US <br /> 6/14/23 <br /> T=Underground Storage Tank <br />