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ppeh <br />,q Appendix XIII <br /> pp. <br /> Underground Storage Tank <br />�ro4r Designated UST Operator Visual Inspection Report <br /> eralt� 1 FACILITY INFORMATION <br /> CERS ID 84725 Inspection Date 6/8/2022 <br />� 101 <br /> Facility Name <br /> West Valley Auto Service LLC <br /> L Facility Address <br /> 2City I ZIP Code Appen <br /> C 615 95304 r9round <br />\\ W Grant Line RD <br /> 2Tracy Aerator <br /> . DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone <br /> 4ATI( Rick Branchini (925) 699-1396 <br /> ICC Certification <br /> 8164986 Certification Expiration Date <br /> 6/3/2024 LLC <br /> 3. COMPLIANCE ISSUES <br /> GVR TLS-350 AFN @ 1:41 PM 6/8/22 <br /> Not in alarm at time of inspection M <br /> Q-2 PLLD Shutdown 5126/22 Self Cleared NFA <br /> ISD VLW 6/2/22 Inspected hoses and Nozzles NFA <br /> ill cl <br /> n file <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> 1 hereby certify that the visual inspection was performed in compliance with California Code <br />)F of Regulations, title 23, division 3, chapter 16, section 2716 and all information provided <br /> herein is accurate. <br /> n Designated UST Operator Signature g p 9 Date Inspection Report Provided to Owner <br /> Digitally signed by Rick Branchini <br /> Date:2022.07.04 18:15:17-07'00' 6/8/2022 <br /> l <br /> CERS = California Environmental Reporting System, ICC = International Code Council, ID = <br /> Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, UST = Underground <br /> Storage Tank <br /> I <br /> UN-111 www.unidocs.org Rev.10101120 Page 1 of 4 <br />