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Appeurdix X[Il <br /> lJnderD—und Storage Tank <br /> Designate€ UST Operator ViswI Inspection Report <br /> 1. FACILITYIHFOfiMATtON <br /> CERS ID 14181335 <br /> cility I�gpgplian Daka 0712$12422 <br /> fa Hama CSI-84276fi705-CHV — - <br /> Facirily Address City ZIP Cade <br /> 2905 W. Benjamin Halt _ Stockton 96207 <br /> 2. DESiGNATED UST OPERATOR INFORMATION <br /> Nameof t•�gnatedU31operator phone <br /> Vivian Va a _ 510-5B1-7652 - - <br /> ICC Cerliricati0rl Certirsralion 1=xpiraliDn Date <br /> 898t R#L# 11 i'23f 2023 <br /> Appendix 7(11[ <br /> Underground Storage Tank <br /> Designeted UST Operator Visual inspection Report <br /> i. EAiCIL)TY INFORMATION <br /> CERS iD limi335 Inspeotl"Date OU1012622 <br /> Fac city NiRrn C51 42{5 1746-CNV - — <br /> Feeility Address Cif ZI R trade <br /> 290S W. Benjamin Holt — �Stockton 95207 <br /> Y- DESIGNATED UST OPERATOR INFORMATION <br /> dame of OesiUnated UST Operator Phone <br /> Vivian Vargas 510x61-7652 <br /> JCC Certification — Certification Expirsdon Date <br /> BJ�$i p83 11 r23=23 <br /> 3. COMPLIANCE ISSUE$ � — <br /> identify by rnjm x�f aU comweance rssaa5 lusted <br /> 1-55 87 Unleaded fill sump alarmed an 12f20 12122 <br /> 2-819 all vents alarmed on 12120 <br /> 3-Si8 Diesel fill sump alarmed on 12122 <br /> •I <br /> 7 <br /> L4. ERTIFIOATl0 BY 0E§lC HAT JD fJSY OPERATpFI COri1aUCTlIdG IN 6 T40N <br /> -}{ I hereby certify#hat tJ�e v' [inspection was performed in corrmplliarme with California Code <br /> of Regulations, title 23 diVi ion 3,chapter 161 section 2716 and all Information provided <br /> herein fs accurate. <br /> Designated 1 P r Sigriatum Date Inspection Report Provided to C+ww <br /> 01110121122 <br /> ERS = Califarrr[s nvirortmenial deporting System, ICC = Internaiionai Cade Council, ID= <br /> ident[ricatinn, NA of Apptioable, UDC =Under-D[spenror Containment. UST =Undergfound <br /> Storage Tank <br /> Page 1 of 4 <br />