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f <br /> ,tion Repo <br /> Designated U <br /> WILSON WAY CHEVRON <br /> 12/31/22 <br /> d 37 fd 6•J I LSCA 952 pate <br /> 1. FACILITY INFORMATION 20OCKTTON23�A'95`05 ction <br /> CERS ID 10181299 ! DEC 31, 2022 1 :02 Pri <br /> Facility Name Chep I ZIP Code <br /> tY Wilson Way 95205 <br /> SVSTEr1 STATUS REPORT on <br /> FacilityAddress FUNCTIONS NORMAL <br /> ALL <br /> 437 N Wilson Way <br /> 2 DESIGNATED UST OPERAT lone <br /> Name of Designated UST Operat 25-389-1262 <br /> Alex Jabbari ertification Expiration Date <br /> ICC Certification18/24 <br /> 5243897-UC ALARM HISTORY kEF'ORT <br /> SENSOR ALARM ----- <br /> 3. COMPLIANCE ISSUES L I :REG AFJNULAR <br /> ANNULAR SPACE <br /> No alarms and compliance issues FUEL <br /> ALARM 6:32 Pry <br /> FUEL ALARM <br /> FEES S, 2022 11 :19 AM <br /> FUEL ALARM <br /> FEB 5, 2022 11 :17 AM <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> I hereby certify that the visual inspection was performed in compliance with California Code <br /> of Regulations, title 23, division 3, chapter 16, section 2716 and all information provided <br /> herein is is ., <br /> Designated UST Operator Signature Date Inspection Report Provided to Owner <br /> CERS = California Environmental Reporting System, ICC = International Code Co <br /> Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, until, Ip <br /> US <br /> Storage Tank T = Underground <br /> UN-111 <br /> www.unidocs.org <br /> Rev. 10/01/20 Page 1 Of 4 <br />