Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(Page i of I) <br /> 1. . 'FACILITY INFORMATION. <br /> Business Name(Same as Facility Name or DBA-Doing Business As.) CERS ID <br /> Harney Lane 76 110181595 <br /> Business Site Address City ZIP Code <br /> 2420 141 E. Harney Lane Lodi 195240 <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training(Print as shown on the ICC Certification.) <br /> Alex A. Jabbari <br /> Mailing Address Phone# <br /> 537 Amherst Court, San Ramon, CA 94583 925 389 - 1262 Ext. <br /> ICC Certification# ICC Certification Expiration Date <br /> 5243897-UC 18/18/24 <br /> 111. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing facility <br /> employee duties. Individuals assuming the duties of the facility employee on and after October 13,2018 must be trained before performing <br /> facility employee duties. <br /> El Check this box if a list of the individual(s)trained is appended to this form. The appended list at a minimum must contain alt of the <br /> information in this section. <br /> Initial Training Date Date of Assuming <br /> Name of Individual( )Trained Responsibility as a <br /> Facility Employee <br /> Garry Singh 12/7/22 6/1/21 <br /> Gurlal Singh 12117/22 4/1/22 <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 provide herein is accurate. <br /> Training Designated UST Operator Signature Date of Training <br /> 12/7/22 <br /> CERS=Califomia Environmental Reporting Systems,ID=ktentification,ICC=International Code Council,UST=Underground storage tank <br />