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rL <br />,� dc <br /> Y l" , � w ter♦ �' .�' ' F , �. <br /> Appendix XIII <br /> Underground Storage Tank <br /> Repo <br /> Designated UST Operator Visual Inspection <br /> 1• FACILITY INFOR <br /> MATION <br /> CERS ID 10180529 Inspection Date 5/18/2023 <br /> Facility Name J & L MARKET & GAS <br /> ZIP Code <br /> Facility Address City FRENCH CAMP 95336 <br /> 8115 S EL DORADO ST 18, <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone <br /> Edward Stearns 209-744-0112 Expiration Date <br /> ICC Certification Certification Exp <br /> 8883080-UC <br /> 3/3/2024 Bol, <br /> 3. COMPLIANCE ISSUES <br /> Identify by number all compliance issues listed <br /> 41" ►� " <br /> Party <br /> np <br /> or <br /> r <br /> 'n of <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 /> Desiqnated UST Operator Signature Date Inspection Report Provided to Owner <br /> 5/18/2023 <br />:ERS = California Environmental Reporting System, ICC = International Code Council, ID = <br /> ientification, NA = Not Applicable, UDC = Under-Dispenser Containment, UST = Underground <br /> torage Tank <br /> Page 1 of 4 <br />