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.... <br />-UNDERGROUND... STORAGE T .. :....... <br />:DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT.' Page 1 of 2 <br />-: <br />d UST t Inspection <br />._...:..FACILITYINFORMATION :. <br />CERS 10 Date of Designate Opera or <br />10132636 8-28-2019 <br />Business Name (Sarno as 1111 Name or DBA -Doing Business As.) <br />(S <br />FLYERS 487 <br />Business Site Address City ZIP Code <br />983 MOFFAT BLVD IIIIIII�TMANTECA 95336 <br />" II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br />Name of Designated UST Operator (Print as shown on the ICC Certitication) Phone # <br />Clent Gagnier 1 (530) 521 - 6818 Ext. <br />ICC Certification # ICC Certification Expiration Date <br />5243792 9-11-2020 <br />Iii. COMPLIANCE ISSUES ' <br />All answer of "N" or "NA"ln sections V11 through Xl must be explained 1n this section and may requlie follow-up action. <br />1. <br />2, NO SUMP OR LEAK ALARMS- MARKED AS NIA <br />3, <br />4. ALL CONTAINMENT CLEAN AND DRY <br />5. <br />6. X- NOT REQUIRED- MARKED AS NIA <br />7, <br />8., NO COMPLIANCE ISSUES <br />9, <br />10. <br />11. <br />12, <br />IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTININE <br />ON <br />................ .. <br />1 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 I OPERATOR DESCRIPTION OF FOLLOW-UP ACTIONS <br />Ali Issue listed in section ill above, must have a description of the ronow-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 111, <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />11. <br />12. <br />VI. OWNER I OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br />1 have reviewed section Ill "COMPLIANCE ISSUES" and provided a description in section V, of the action taken or to betaken <br />to correct the Issues discovered. D to Signed <br />Name of UST OwneriOperator (Print) UST Owner/0 :Mature — 9 <br />is MAK�4 U <br />di <br />CERS California Environmental Reporting System ID = Identification, UST =Underground storage tank ICC = International <br />Code Council <br />