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UNDERGROUNDST <br /> GETANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page t of 2) <br /> L FACILITY INFORMATION <br /> CERS ID <br /> Date of Designated UST Operator Inspection <br /> 10181231 02/06/2020 <br /> Business Name (Same as Facility Name or DBA•Doing Business As) <br /> Tesoro : 68152 SP: 4945 <br /> Business Site Address City ZtP Code <br /> 401 W KettieMan Lane Lodi 95240 <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Print as shown on the ICC Certification.) Phone # <br /> Scott Mills (949) 4604200 <br /> ICC Certification # ICC Certification Expiration Date <br /> 9495323 12118/2021 <br /> I ' <br /> III. COMPLIANCE ISSUES <br /> All answers of *'Na' or "NA " in sections Vll through Xl must be explained In this section and may require lollow-up action. I <br /> 1 . Site has double-walled tanks. <br /> 3. <br /> Site has double-walled lines. — <br /> ii <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> I hereby certify that the visual inspection was performed in full compliance with California Code of Regulations, Title 23, <br /> Division 3, Chapter 16, Section 2716 and all the information provided herein is accurate. <br /> Designated UST Operator Signature <br /> L� <br /> V. OWNER / OPERATOR DESCRIPTION OF FOLLOW-UP ACTIONS <br /> All issues listed in Section I// above must have a description of the follow-up action taken or to be taken to correct the issue on the number <br /> line that corresponds with the number line of the compliance issue listed above in Section fll. <br /> 1 . No follow"up required. <br /> 2. No follow"up required . <br /> VI . OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> t have reviewed Section III "COMPLIANCE ISSUES" and provided a description in Section V of the action taken or to be taken <br /> to correct the issues discovered. <br /> Name of UST r/Operator (Print) UST Owner/Operator Signatu Date Signed <br /> \ A Ce Z A, 2� <br /> CERS = California Environmental Reporting System, ID = Identification. UST = Underground Sloiage Tarn, ICC = teemational Code Card <br />