Laserfiche WebLink
Appendix XIII <br /> Underground Storage Tank <br /> UST 0 tion Report <br /> Operator Visual inspec <br /> p <br /> 1. FACILITY INFORMATION Inspection Date <br /> CERS ID 10181611 <br /> Facility Name Jahant Food & Fuel ZIP Code <br /> City 195270 <br /> Facility Address Acampo <br /> 24323 N. Hwy 99 <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Phone <br /> Name of Designated UST Operator r,f �� 916-371-2380 <br /> BZ Service Station Maintenance, Incie; �� �`"' iration Date <br /> Certification Exp <br /> ICC Certification -7� :- <br /> , <br /> 3. COMPLIANCE ISSUES <br /> 1 !"��✓t+�v"Ga� Gt�-1CJ .S'�..r`!-�"r�( �,C e t".��" �O �� �G��✓�f �'G..' <br /> .L ►-�� cxcllf I-ery <br /> j, 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> 1 he 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 /> FDesig­natqcL�QST�petor Si <br /> ragnature 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 />