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s <br /> FACILITY EMPLOYEE TRAIN UNDERGROUNDSJGRAGE TANK <br /> CERTIFICATE(Page 1 of 1) <br /> Business Name(Same as Facility Name or DfA-Doing Bus!nessAAsCILITY INFORMATION <br /> One Stop Market- Chevron 'EE-RS ID <br /> Business Site Address 110186837 <br /> 1151 W. Luise Ave V <br /> ZIP Code <br /> Manteca <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION 85336 <br /> Name of Designated UST Operator Providing 1:he Training(Prnt as shown on te ICC Certification.) <br /> Alex A. Jabbari h <br /> Mailing Address <br /> Phone <br /> 537 Amherst Court, San Ramon CA 94583 925#389- 1262 Ext. <br /> ICC Certification# <br /> 5243897-UC ICC Certification Expiration Date <br /> 8/18/24 <br /> III. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facillity employee before October 13,2018 must be trained within 30 days of performing facility <br /> employee duties. Individuals assuming the duties of the facility employee on and after October 13,2018 must be trained before performing <br /> 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 all of the y 4. <br /> information in this section. <br /> Initial Training Date Date of Assuming <br /> s Trained Responsibility as a <br /> Name of Individual4r <br /> Facility Employee � ��•; <br /> f. <br /> 'f <br /> Kathy Phillips 3/9/20 3/10/20 't <br /> Rapinder Kaur 6/9/21 6/10/29 <br /> t <br /> fit, i <br /> �r 1 <br /> ,?1 <br /> f; <br /> j <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The facility employees listed above have completed the required training in accordance with California Code of Regulations, <br /> title 23,division 3,chapter 16,section 2715(c)and all the information provide herein is accurate. <br /> Training Designated UST Operator Signature Date of Training <br /> 1117123 <br /> CERS=California Environmental Reporting Systems,ID=Identification,ICC=International Cade Council,UST=Underground storage tank <br />