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UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(Pw i o11) <br /> I. FACILITY INFORMATION <br /> Business Name(Seine as Facility Name or DSA-Ddne 9usmess As) CERS iD <br /> Quik StopMarket#144 10180967 <br /> B,niness Site Address CRY <br /> 72 ZIP lade <br /> 72 West Lane Stockton, CA 95210 <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator P-o i g ft Training(Pent as sne n on di.rcc C-,Vf c lbn.) <br /> Joel Barrera <br /> Meiling Address Prone e <br /> P.O Box 1025 W. Sacramento Ca, 95691 918 372-1888 <br /> ICC Cerescadon& 10195375 icc Cennicagon a omnan Date 10/9/2026 <br /> Ill. FACILITY EMPLOYEE INFORMATION <br /> individuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing <br /> facility employee duties.Individuals assuming the duties of the facility employee on and&flat October 13,2018 mwtbauained <br /> before performing facility employee duties. <br /> Check this box No list of tin individuai(s)trained is appended to this form. The appended list,"a minimum,must contain <br /> El all of the information in this section. <br /> Date of Assuming <br /> Initial Training Data Rasponsibllity as a <br /> Name of Individual(s)Trained Facllhy Emptoyae <br /> BalwinderSomal 7/1/2025 7l1/2025 <br /> Surinder Kaur <br /> 7/1/2025 7/1/2025 a <br /> 1 <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The facility employees listed above have completed <br /> and d the required <br /> the information providedIn accordance here'naccurate- <br /> Titlewith <br /> California Code of Regulations, <br /> 23, Division 3, Chapter 16, Date of Training <br /> 7/1/2025 <br /> Training Designated UST oper <br /> ator Signature <br /> CER6=Coom s EfseonnolW Reporting fin• <br /> W=Idaf ICC=Inern�"Code Cutalal.UST=Uda4a+d Slorage Tads <br />