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UNDERGROUND STORAGE TANK e 1 of 1) <br /> C,,,Ty EMPLOYEE TRAINING <br /> ORMATI CERTIFICATE (Pag <br /> FA I. FACILITY INF CERS ID <br /> �gSFapliryNama or DBA-Doing <br /> Business As) 10181433 Zip Code <br /> City 95219 <br /> STOCKTON <br /> A 40 <br /> DESIGNATED UNDERGROUND STORAGE CANKCertificOPERATOR INFORMATION <br /> 11• the Training(Print as shown <br /> on the al�ygnaf,d UST Operator Providing <br /> Phone# <br /> ��Bell (408)971-2445 <br /> �a�pddress j <br /> fgppmnnAve San Jose CA 95112 ICC Certification Expiration Date 10/27/23 <br /> ICCCertificaiion# 8833000 <br /> I III. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing <br /> individuals <br /> ty employee duties.Individuals assuming the duties of the facility employee on and after October 13, 2018 must be trainedfaci -e <br /> before performing facility employee duties. <br /> Check this box if a list of the individual(s)trained is appended to this form. The appended list, at a minimum,must contain <br /> all of the information in this section. <br /> Date of Assuming <br /> Name of Individual(s)Trained Initial Training Date Responsibility as a _ <br /> Facility Employee <br /> Tiffany Fite 03/21/23 01/10/08 <br /> Natalie Vincent 03/21/23 08/07/19 <br /> IV. CERTIFI <br /> The facility em CATION gy DESIGNq <br /> Title 23,Divisio�l gyees listedTED US <br /> above have co <br /> Trainin Chapter 16,Sectio mpleted t T OPERgT�R C <br /> g Designated UST Opel for n 27151c)and alht required trainin ONDUCTING THIS <br /> atu he information g In accorda TRAINING <br /> provided hereinCe`Ntth California <br /> CERS=Ca"orniaEnvironmentalRepo�ngSyster"D_Id is accurate Code Of Regulations <br /> enbfigtpn,IC Date <br /> C=Intern of Training <br /> international Code Council, 3/21/2 <br /> -Under 3 <br /> ground Storage Tank <br /> 1 <br />