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Appendix XIII <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> i <br /> 1. FACILITY INFORMATION <br /> CERS ID <br /> L_ 10594654 Inspection Date 0812512023 <br /> [Failit ' <br /> y Name H&S Energy Products,LLC 3081 <br /> Facility Address Code <br /> City �9�5207 <br /> 6633Pacific Ave Stockton <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone <br /> Fernando Solis (949)781-5765 <br /> ICC Certification Certification Expiration Date <br /> 10293936 4/5/2025 <br /> 3. COMPLIANCE ISSUES <br /> 1. Initial secondary containment testing completed on 3/23/23 has failing components. UDC test for UDC's 7-8,9-10, <br /> 11-12. <br /> t' <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 accurate. <br /> Designated UST Op r 'gnature Date Inspection Report Provided to Owner <br /> 08/25/2023 <br /> I <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 />