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12 / 20 / 2018 11 : 12AM FAX 2098236719 ONE STOP MARKET CHEVRON 1210004 / 0004 <br /> UNDERGROUND STORAGE TANK <br /> D SI GNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1 of 2) <br /> L FACILITY INFORMATION <br /> CE S Its - "" a12119/2018 <br /> a 4f Ublgnatud IlF9T Oporatgrin6poCtion <br /> 1 8p561 <br /> t3U iness Name (Same as Fpcllity Nernoar DBA- aging Bum Inoss As.) <br /> - _ .. . . ,..,.,.�. City � LIP Code . .__ <br /> Man#eca 958 $6 <br /> 3113NATED UNDERGROUND STORAGE TANK OFERATt)R INFORMATION <br /> r {Fant asshown on tho ICC Cenincntion,j Phone # <br /> T( 925) 889 - 1262 Ext . <br /> 1 51 Q . ;.'i ! ) I SF.. ,PAVE ICC Certification Expiration Date <br /> 111 ,4,01TEPOA 10/01 /2020 <br /> ;: ] �i � ' 3 - Ciel - • • —,. . .. .--- - - ... <br /> III . COMPLIANCE ISSUES �- <br /> I'. '� u 1 ., . 01 O 8 : 51 141,11 is V/1 is Xt must bo oxplained In <br /> this soation and may requite foll4w•up action, <br /> rtLL FUr''TIC, w�; NGRI,ItiL <br /> JENTAL <br /> '� �TMEN <br /> 1 . I . L. SP ^ <br /> 1112E 1'Hi`l <br /> 0 jT i•iLt•1R1°I <br /> Ieo= 018 11 : 11 ril°I TION BY DESIGNATED UST, OPERATOR CONDUCTING THIS INSPECTION <br /> tl inspection was performed In full compliance with California Code of Regulations, title 23, <br /> j' 1tF DA 'ti WHkiV 11V�_. p :- <br /> : n 2716 and all the Information rovidedeperein Is accurate. <br /> re <br /> Ci;� r�11"t / , <br /> 1 ' =i' Z 18 11 : L.18 jai°l f" <br /> OWNER / OPERATOR DE +CRIPTION OF FOLLOW-UP ACTIONS - <br /> must nave o description of the follow-up action tpkon, or to be takon, to eorroctthe issuo on the numbor line that <br /> ry compliance issuo is listed above in section lit. <br /> END <br /> A l�VF'{3JYl; <br /> 11 . - <br /> 'rhato <br /> 2 . <br /> VI . OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES _ <br /> v vroviewed section III "COMPLIANCE ISSUE$" and provided a description in section V, of tho action takon or to bo taken <br /> q rect tho issues discovered , <br /> 1 Name of UST Owner/Oporator (Print) �' UST Owned/t7parstpr Signature ��/ + t7:�te Signe¢ <br />