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- Appendix XIII <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 1. FACII-11TY INFORMATION <br /> CERS ID 10844113 Inspection Date <br /> Z <br /> Facility Name Harney Lane 76 <br /> -------------- <br /> Facility Address City195240 ZIP Code i <br /> 141 E. Harney Lane Lodi <br /> 2. DESIGNATED'UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone <br /> BZ Service Station Maintenance, In ' , 916-371-2380 <br /> ICC Certification Certification Expiration Date <br /> 7 2 <br /> 3. COMPLIANCE ISSUES <br /> I <br /> I <br /> I <br /> 4. C RTIFICATION 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 /> I <br /> is accurate. <br /> Designated UST Operator Signature Date Inspection Report Provided to Owner <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 /> Page 1 of 4 <br />