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4 <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE waq,,I <br /> or tl <br /> I. FRF,! 10180561 <br /> FACIL INFORMATION <br /> CALON 95320 <br /> ')SF B� <br /> '1"C',*A'I'k'-)'N" l","T N� <br /> 1o5't- Y(_ - ITE NFORI�ATION__ <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR 11_ <br /> L_IEi IX RAI.4'REZ!" <br /> A' �09) 71' <br /> - t, ( _�-9211 <br /> 0 BOX 1:'.a4 LAFAYETI E CA 95459 <br /> Dal, 2117.(2026 <br /> 8883072-UC <br /> ON <br /> FACILITY EMPLOYEE_I.NFORMATI <br /> "In <br /> duties of the facility employee before October 13.2018 must be trained within 30 day's of Performing <br /> individuals assuming tho bar 13,2018 must be traifOd <br /> (31:111ty employee duties.Individuals assuming the duties()f the facility employee on and after October <br /> b,fL)rc performing facility employee duties. <br /> list.at a minimum,must contain <br /> r- — <br /> Ch.vhi this box if a fist of the individual(s)trained is apperideld to this form Theappendod <br /> au o(theinfarmatiort Pei this section. <br /> Initial Training Date Responsibility as a <br /> t <br /> and aft 0 <br /> b <br /> 2 <br /> c 0 Of <br /> 8 <br /> t a <br /> P must <br /> uf As!' <br /> r'�Jb' <br /> L <br /> contain <br /> .."'Ing, <br /> Em I"as e <br /> 0/ <br /> P end"d I's t. m n mur"' <br /> Dat� <br /> ,.I T g D. Re. <br /> r --Name of IndiViCIL131(s)Trained In Training Date <br /> Fadlity EMPIOYLe <br /> 11/20/2024 11/20/202�4 <br /> I JASRAT SINGH <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The facility employees listed above have Completed the required training in accordance with California Code of Regulatiom, <br /> Title 23,Division 3,Chapter 116,Section 2715(c)and all the information provided herein is accurate. <br /> Designated UST Operator Signature raining <br /> 97 11120/2024 <br /> Cd,UST=Urwje nd SkX T <br /> r1al oun jw age ar* <br />