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Appendix X11 Underground Storage Tank Facility Employee Training Certificate (Page 1 of 1) I. FACILITY INFORMATION — Business Marne (Same as Facility Warne or DBA -Doing Business As) CERS 1D !!Gar, &Shop ,— Business Site Address pity ZIP Code 1002 Frontage Rd Ripon 95366 11. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION Name of Designated UST Operator Providing Training (Print as shown on the ICC Geilifivation) Guadalupe Sanrhez Mailing Address Phone 3619 King CT Mooch. CA 94509 9 5-470-080,3 IOC Certification # ICC Certification Expiration Date 5250451 ; 112112025 III. FACILITY EMPLOYEE INFORMATION Individuals assuming the duties of the facility employee before October 13, 2018 must be trained within 30 days of performing facility employee duties. Individuals assuming the duties of the facility employee on and after October 13, 2018 must be trained before performing facility employee duties. El Check this box it a lrsf of the individual(s) trained is appended to this farm. The appended list at a minimum must contain all of the information in this section. Y Date of Assuming Name of Indivldual(s) Trained Initial Training Date Responsibility as a Facility Employee Ramesh Prakash 121512024 121512024 D z I Cesar Arnilcar 121512024 121512024 l Amarbir Singh 121512024 1215I2024 20z I&S agog Singh 1215RO24 121512024 cp z-,r. z y I I IV. CERTIFICAT'I'ON BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAININ The facility employees listed above have completed the required training in accordance with California Code of Regulations, Title 23, Division 3, Chapter 16, Section 715(c) and all the information provide herein is accurate. Training De.?gnated UST Op rrator Signature Date of Training a CERS - alifomia Environmental Reporting System, ID = Identification, ICC = Internatinnal Code Council. UST = Underground storage tank