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IN�HLtI� V11 L Liv I pn <br /> \Am 115. za�1 <br /> pROBF, OUT <br /> \BAR 23. 201 a 2 42 tPt <br /> MAR 23. 201 a 1'�'.29 aeA <br /> MAR 20 2C�\8 `� Appendix XIII <br /> Underground Stora <br /> ge Designated UST Operator�Sual Inspection Report <br /> -i_ FACILITY INFORMATION <br /> CERS ID 10760026 <br /> Facility Name — Inspection Date <br /> Trinity Pkwy AM _ pM <br /> Facility Address <br /> 10715 Trinity Pkv, City -4 <br /> 2. DESIGNATED UST OpE Stockton ZIP Code <br /> RATOR INFORMATION 195219 <br /> r.- <br /> Name of Designated UST Operator m <br /> 13Z Service Station Maintenance, Inc Phone <br /> ICC Certification ? 916-371-2380 <br /> O �" Certificationc <br /> 3. COMPLIANCE ISSUES <br /> 4. CERTIRCATION 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 Repgrt Pryi�e� �ner <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 />