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Received <br /> 3/8/2023 <br /> sltlrl i �lilrl � � <br /> OPEN END OPEN END <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE 1page w 11 <br /> I. FACILITY INFORMATION <br /> (Same as Fim Name a •Doap OaA9uw»aa Aa) CERS ID <br /> f � � <br /> dV P Code <br /> U. DESIGNATED UNDORGROUND STORAGE TANK OPERATOR INFORMATION <br /> ed UST Operator P101rtl ng die Trainatg(Pi&W as Mm,,err ys+CC CMabcsfun m <br /> ImRTO <br /> Street Galt CA 95632 phom a <br /> 209 744-0112 <br /> a ICC Cem6rieon Eapnanon Date _ <br /> 8883064-UC 2/2512020 <br /> III. FACILITY EMPLOYEE INFORMATION <br /> uals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing <br /> employee duties.Individuals assuming the duties of the facility employee on and after October 13.2018 must be trained <br /> Performing facility employee duties. <br /> Ock this box ff a U3t of the Indivkh-f(s)trained is appended to th <br /> Of the Information in this soctlon. is loan. The appended list,at a mrnlmum,must contNn <br /> I <br /> Dau of Assuming <br /> Name of Individualls)Trained Initial Training Date R sponsiba ty as a <br /> FwAky Employ" <br /> N e C' 3 <br /> 3 <br /> iz / zz. <br /> 19 2 2 <br /> ware <br /> IV. CERTIFICATION 13Y DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING _ <br /> f aelifty Dlyfemployees <br /> listed above have completed tiprovided ning Californiaordance vvith Code of Regulations, <br /> Sion Section 27 )and all the information herren is accurate, <br /> UST Operator S9,Wure Dre Qt Tr ni� <br /> Ermmw"A Rems9 Sylsn,D ICC•t Code C ur4 UST•Lkda7mm Swage Tar* <br />