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t qC "nuEROROUN 3 STORAGE TANK <br /> B'mnetsName/SansasF -%.;. E MPLOYEE TRAINING CERTIFICATE(Papa 1 of1) <br /> eGa3C0 ep�+YNensorpeq. I' FACILITY INFORMATION <br /> 17 p yo Address ,,,V <br /> smite CERS ro <br /> p. _ 10181431 <br /> Name or OESIGNATED Manteca rP Code <br /> �++pnall UST UNDE 95338 <br /> PEeshyOpd�7pj8tpr Proreuwg the Tra nU�DNSTORApEcTAC N 11, p /gATOR INFORMATION <br /> O. 8ox 16 <br /> ICC Certacatbn 2 Lodi3 <br /> OdI CA 95241 <br /> Phl s <br /> 8032295 rcc C-Mcaaoo Epr—Dat. 209 518-4836 <br /> IntllrldUsIs a IN. FACILITY EMPLOYEE INFORMATION 8/31/2026 <br /> facility em mourn I the duties of the faclll berore Pioyaa duties.Individuals astumM emPtoyse before Performing faclNt ent l0 9 the duties of t October 13.2n'a must be trained within 30 days of <br /> Y P Yao duties, ty emPloyes on and after October 13,201 a must be trained <br /> Cl Check this Gox ry a"at Of esndivldua!(sJ Ualnsd!a aPlMndsd to <br /> this form. <br /> The a <br /> afJ oI the InfonnaUon/n _ <br /> ect/on. <br /> PPended list,of a m!n/mum,must contemn <br /> Name of Individu lh)Trained <br /> Initial Tralnin t0ats of A.au,,,t,� <br /> g Dab Rp Employ" <br /> as a <br /> Fscgft Lt 1 -2 <br /> r <br /> . L - u25- <br /> lY• CERTIFICATION BY DESIG <br /> The facility employees Ilatad above have DESIGNAthe ED UST OPERATOR CONDUCTING 1 HIS T <br /> The slop 3,Chapter a ovehn 271 required trainingIn RAINING <br /> 6(c)and all the Information accordance with California Code of R T ared,UST O Provided heroin is accurata egulatlolls, <br /> Pe for Sig lure <br /> Date of Training O-A <br /> GIBSC ft, 8/14/2025UJV-112 e D=ideralicail ICrg ga+ri UST _ <br /> =1►tls hard Stnragp Tal <br /> 1N-Rw.10/M118 <br />