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EMO id (MCR) <br /> 39-PFJ-617 <br /> 00 <br /> AL <br /> PMonthly Designated operator Inspections Underground Storage Tank(UST)Monthly Visual Equipment <br /> facial asci usTo(8786) and Records Inspection Compliance Summary <br /> Rev:11/18/2011 <br /> FACILITY INFORMATION: <br /> To(Facility Owner or Operator): Facility Contact Contact Phone#: <br /> PILOT/ FLYING J JOSE JIMENEZ (209) 339-4066 <br /> Facility Name: CUPA Facility ID#: PTO Exp.Date: <br /> PILOT/ FLYING J - LODI #617 FA0012979 12/31/2013 <br /> Facility Address: Date of Inspection: <br /> 15100 THORNTON Pb. <br /> LOU, CA 95242 23 l� <br /> DESIGNATED OPERATOR DO INFORMATION: <br /> Designated Operator's Name: Relation to UST Facility: (Check One) <br /> LANCE YORK <br /> Business Name(if different from above): ❑ Owner ❑ Operator ❑ Employee <br /> UST OPERATORS OF SOUTHERN CALIFORNIA <br /> Designated operatorsPhone#: ❑ Service Technician N Third-Party <br /> 949) 458-8786 949) 230-8931 <br /> International Code Council Certification#: Expiration Date: <br /> 5296385-UC SEPTEMBER 1, 2014 <br /> ADDITIONAL FOLLOW UP TASKS REQUIRED: <br /> .�' C��1,0�[EEi c�to•.�C NGt��J 11J r (Z-cJ <br /> UPCOMING TEST AND RECORDS DEADLINES: <br /> Annual Monitoring System&LLD Certification: 5 `�. AB 2481 Annual Fill/Spill Box Tightness Test: 7mou <br /> Z_ 9SB 989 Secondary Containment Tests: Hazardous Materials Business Pian: <br /> Certificate of Financial Responsibility: —`— Vapor Recovery System Re-Verification: ZO(I <br /> UPCOMING UST COMPLIANCE TRAINING DEADLINES: <br /> e • • e e • <br /> STACEY CI EROS * LOA 09/18/13 <br /> JOSE JIMIK!g 01/17/14 <br /> PETER NESS 01/17/14 <br /> MARIA SOLWAY_,* 02/14/14 <br /> FR DDIE PHREYS * 04/17/14 <br /> JESSICA FOSSGATE* 04/17/14 <br /> JESSE MARTINEZ* 04/17/14 <br /> KENNETH bURADO * 04/17/14 <br /> TAMMY SERRANO * 08/23/14 <br /> *Completed initial UST Compliance Training <br />