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UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(Page 1 of 1) <br /> 1. FACILITY INFORMATION <br /> BARCO AM PM # 83831 usiness Name(Same as Facility Name or DBA-Doing Business As) CERS ID <br /> 10761034 <br /> Business Site Address City ZIP Code <br /> 1904 Daniels St Manteca 95337 <br /> ll. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training(Print as shown on the ICC Certification.) <br /> Guadalupe Sanchez <br /> Mailing Address Phone# <br /> 3619 King Ct Antioch, CA 94509 (925)470-0803 <br /> ICC Certification# ICC Certification Expiration Date <br /> 5250451 1/21/2025 <br /> Ill. 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 /> facility employee duties.Individuals assuming the duties of the facility employee on and after October 13,2018 must be trained <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 /> Ranjeet Singh 4/10/2018 4/10/2018 <br /> Vikramjeet Singh 4/10/2018 4/10/2018 <br /> Tracie Jones 4/10/2018 4/10/2018 <br /> Danielle Feliz 3/13/2021 3/13/2021 <br /> Stacey Lindauer 3/13/2021 3/13/2021 <br /> Lisa Thibeaux 3/13/2021 3/13/2021 <br /> Regina Payden 2/2/2023 2/2/2023 <br /> Jessica Kulp 2/2/2023 2/2/2023 <br /> Kelly Lipman 2/2/2023 2/2/2023 <br /> Renee Thibeaux 2/2/2023 2/2/2023 <br /> Juan Barrientos 2/2/2023 2/2/2023 <br /> Shannon Aceves 2/2/2023 2/2/2023 <br /> Chanell Barlese 2/2/2023 2/2/2023 <br /> Brian Boa 2/2/2023 2/2/2023 <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 provided herein is accurate. <br /> Training Designated UST Operator Signature Date of Training <br /> f_ Q 2/2/2023 <br /> CERS=CaUfomia Envirmmental Reporting System,IDX Identification,ICC=Intemationa!Code Council UST=Underground Storage Tank <br /> UN-112 www.unidocs.org 1/1-Rev.10/01/18 <br />