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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 />Facility Name <br />2. DESIGNATED UST OPERATOR INFORMATION <br />Name of Designated UST Operator Phone <br />ICC Certification Certification Expiration Date <br />3. COMPLIANCE ISSUES <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 Operator Signature Date Inspection Report Provided to Owner <br />1. FACILITY INFORMATION <br />CERS ID Inspection Date <br />Facility Address City ZIP Code <br />Alyssa Lesso