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UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1 ) <br /> I . FACILITY INFORMATION <br /> Business Name (Same as Facility Mame or DBA-Doing Business As) CERS ID <br /> UNOCAL 76 10181433 <br /> Business Site Address City ZIP Code <br /> 2701 MARCH LANE ISTOCKTON 95219 <br /> 11 . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training (Print as shown on the ICC Certification.) <br /> Samantha McMahan <br /> Mailing Address one # <br /> 680 Quinn Ave San Jose CA 95112 (408) 971 -2445 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8950093 2/27/25 <br /> Ili. 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 /> Karen Montgomery 09/13/19 09/13/19 <br /> RAJVEER SINGH 06/14/23 06/14/23 <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 /> � 6/14123 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council, UST = Underground Storage Tank <br />