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UNDERGROUND STORAGE TANK <br />DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1012) <br />I. FACILITY INFORMATION <br />CERS ID <br />10181455 <br />Date of Designated UST Operator Inspection <br />1/03/20 <br />Business Name (Same as Facility Name or DBA-Doing Business <br />UNFI <br />As.) <br />City <br />Stockton <br />ZIP Code <br />95215 <br />Business Site Address <br />1990 Piccoli Road <br />II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br />Name of Designated UST Operator (Print as shown on the ICC Certification.) <br />Erik Brown <br />ICC Certification # <br />8883731 <br />ICC Certification <br />1/30/20 <br />Phone # <br />(209) 931 - 7438 Ext. <br />Expiration Date <br />III. COMPLIANCE ISSUES <br />All answer of "N" or "NA" in sections VII through XI must be explained in this section and may require follow-up action. <br />No leak detection alarms <br />No leak detection alarms in sump <br />Tank tightness test not required <br />Line tightness test not required <br />c U. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <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 />V. OWNER OWNER / OPERATOR DESCRIPTION OF FOLLOW-UP ACTIONS <br />All issue listed in section III above, must have a description of the follow-up action taken, or to be taken, to correct the issue on the number line that <br />corresponds with the number line the compliance issue is listed above in section III. <br />No leak detection alarms, no action needed <br />No leak detection alarms, no action needed <br />Tank tightness test not required <br />Line tightness test not required <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />VI. OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br />I 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 Owner/Operator (Print) <br />Erik M. Brown <br />UST Owner/Operator Signature <br />PA-- A-Irr-----'- <br />Date Signed <br />01/03/20 <br />('FPS = C.alifnmia Fnuimnmpntal Ppm-It-firm Sztm in = Iripntifiratinn I 1ST = I InriPmrni Ind ctnranp tank irr = IntPmatinnal rnrip (In; inril