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UNDERGROUND STORAGE TANK <br /> FACI EMPLOYEE TRAINING CERTIFICATE (Pagel of 1) <br /> 1. FACILITY INFORMATION <br /> Business Name(Same as Facility Name or -Doing Business As.) CERS ID <br /> Bill's 76 11018063 <br /> Business Site Address City ZIP Code <br /> 633 E. Victor Road Lodi 95240 <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training(Print as shown on the/CC Certification.) <br /> Alex A. Jabbari <br /> Mailing Address Phone# <br /> 537 Amherst Court, San Ramon, CA 94583 925 389- 1262 Ext. <br /> ICC Certification# ICC Certification Expiration Date <br /> 5243897-UC 10/1/2020 <br /> III. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing facility <br /> employee duties. Individuals assuming the duties of the facility employee on and after October 13,2018 must be trained before performing <br /> facility employee duties. <br /> Check this box if a list of the individual(s)trained is appended to this forth. The appended list at a minimum must contain aft of the <br /> information in this section. <br /> Initial Training Date Date of Assuming <br /> Name of Individuals)Trained Responsibility as a <br /> Facility Employee <br /> Lisa Claris 12/27/19 2005 <br /> Shakael Khan 12/27/19 2016 <br /> Ahmad Ali 12/27/19 2015 <br /> Fiaaz Mohammed 12/27/19 4112119 <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The facility employees listed above have completed the required training in accordance with California Code of Regulations, <br /> title 23,division 3,chapter 16,section 2715(c)and all the information provide herein is accurate. <br /> Training Designated UST Operator Signature Date of Training <br /> 7 12127/19 <br /> CERS=California Environmental Reporting Systems,ID=Identification,ICC=International Code Council,UST=Underground storage tank <br />