Laserfiche WebLink
' a <br /> UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERTOa,�ISUiaL INSPECTION REPORT Page;of <br /> I . FACILITY INFORMATION <br /> Date of Designated UST Operator Inspection . 400 <br /> Had <br /> CERS ID <br /> lD � yb5Z3 ' <br /> Business Name (same as Facility Name or DBA-Doing Business As) <br /> A R C v A r.. leow, 3 b' I 2- City ZIP Code <br /> Business Site Address <br /> Z 2 S cc, ,tQ rr. f 7„ e S C 4 a>^ <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Pont as shown on the ICC Certification.) Phone # <br /> ICC Certification # ICC Certification Expiration Date <br /> SrZ C3 I 1 41, 24 .,. ?' C3 1 5 <br /> 111. <br /> COMPLIANCE ISSUES <br /> All answers of "N" or NA " in sections Vll through XI must be explained in this section and may require follow/-up action. <br /> Me lIr / <br /> c^� 4 � e 't� T, ' �Er � CA. tti ✓ 7J 4 s r !'� d✓t rj �pr �17 <br /> 20 _ .f � - n P 'N!�� — . — 4.. [/ ✓ Pl Fi >✓ l �!2✓ttii •1 r , <br /> 1 <br /> We <br /> 3 . �. Dr - . ow Zo W �� Gam- � <br /> � v urs w 11 ' I . I � <br /> 4. �� � � � v �'- lay- �� _vr c� A arm- .. VLM , d ��o rLt <br /> �j'i= - - — <br /> 5. L � 'D, ,v / t — i2 : a A e-- .,. w. /- 22 • , 12 AQ- lee✓ <br /> 7. 1-etA T 1 / c / - a� J (f Jt t4 1�"i- vno pt 1 1 <br /> 8 <br /> 1 rt f' j,: a Tal ^ 01F <br /> < ficchite dae e- cj�-d , o✓ Y% o re- rr <br /> 9. 1JVW <br /> 10. <br /> 12a H <br /> - ------ ------- ---- ---- - - -- <br /> IVd CERF 40ATMBYIDEMNATED' USTOPERATOR CONDUCTING THIS INSPECTION <br /> I hereby certify that the visual *rspe>fon .vms performed in full compliance with California Code of Regulations , Title 23 , <br /> Division 3, Chapter 16, Section2716 andall the information provided herein is accurate . <br /> Designated UST Operator Signa 1 — - <br /> � <br /> *tl. OWNER / CVRERATOR DESCRIPTION OF FOLLOW-UP ACTIONS <br /> All issues listed in Section !11 above crust have a description of the follow-up action taken or to be taken to correct the issu& on the number <br /> line that corresponds withthe nu+nber line of the compliance issue listed above in Section tit. <br /> 1 . <br /> -- - ---- - --- -- -- - - - - - - -- <br /> 3 . , y ► - - <br /> 54 <br /> -- ---- ---- <br /> - ----- - -- - - -- - --- -- - <br /> 6 . — - -- -- — — -- - <br /> ------- - <br /> Be - - - - -- — — - - <br /> 9 . --- - - - - - - - - <br /> 12. - - --- - - - - -- — - - - - - --- - - <br /> vl. _ OWNER 1 OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> have correct <br /> reviewedhis Section tt4 "COMPLIANCE 15SUEc ' a � provided a description in Section V of the action taken or to be taP.- <br /> o correct the issues discovered . _ 4.4 <br /> ' Name of UST U eerloperator (Print ) <br /> UST OwnP !Operator Signature 7 FDaleigned <br /> = Caiiforrria Envtt rur)ental �g System, ID = IdenFcaSorti UST = U xlergmund — <br /> Slorage Tank, ICC International Code Council <br />