Laserfiche WebLink
Appendix XIII <br /> Underground Storage Tank action Report <br /> Designated UST Operator Visual Insp <br /> P <br /> GiLUY INFORMATION ID 10181611 Inspection Date ;t y <br /> Facility Name Jahant Food 8 Fuel <br /> ZIP Code <br /> 1Facility Address City 95270 <br /> 24323 N. Hwy 99 �Acam!30 <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone <br /> BZ Service Station Maintenance, Incl p 916-371-2380 <br /> ICC Certification Certification Expiration Date <br /> 3. COMPLIANCE ISSUES <br /> Ll 161100,, DSI- 5 to q-1; 2y <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 erator Signature Date Inspection Report Provided to Owner <br /> CERS = Callfomia 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 />