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UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE ( Page 1 of 1 ) <br /> 1 . FACILITY INFORMATION <br /> Business Name (Same as Facility Name or DBA-Doing Business As) CERS ID <br /> West Valley Auto Service LLC 10184725 <br /> Business Site Address City ZIP Code <br /> 2615 West Grantline Road Trac 95304 <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 /> Rick Branchini <br /> Mailing Address Phone # <br /> 106 Wessex way Folsom , CA 95630 925 699 - 1396 Ext, <br /> ICC Certification # ICC Certification Expiration Date <br /> 8861986 6/21 /202n <br /> Ill . 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 Individuals) trained is appended to this form. The appended list at a minimum must contain all of the <br /> Information in this section. <br /> Initial Training Date Date of Assuming <br /> Name of Individual(s) Trained Responsibility as a <br /> Facility Employee <br /> Hakimi Wais 1 /29/20 10/01 / 16 <br /> Benito Cordova 04/ 10/ 19 01 /31 / 17 <br /> Sayeed Emran 01 /05/20 7/01 / 17 <br /> Nency Zaveri 1 /29/20 12/14/ 18 <br /> Selena Alexis Ponce 9/ 11 /198 9/30/ 19 <br /> Cassie Lazar 1 /5/20 12/20/ 18 <br /> David Kennith Lee Jr. 9/ 11 / 19 9/30/19 <br /> Virjot Dhaliwal 9/ 17/ 19 9/30/ 19 <br /> Navjot Tili 9/ 11 /19 9/ 15/19 <br /> See sumplmental forms attached <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 0 e or Si ature <br /> Date of Training <br /> See Supplemental Forms <br /> ere <br /> CERS = California Environmental Reporting Systems, ID = Identification, ICC = International Code Council, UST = Underground storage tank <br />