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Y EMPLOYEE TRAINING CERTIFICATE ( Page i of 1 ) <br /> Business Name ("Same as Facility Name or D13A -Doing Business As) <br /> _- - <br /> 1 • FACILITY INFORMATION <br /> Busjtie—SSG fie <br /> d reLs� M ( ►J t CERS ID <br /> a S E #tf t ?E c. ilY _ ZW Code <br /> DESIGNATED UNDERGRS�` � � 53Z0 <br /> Name of D�d DsT Operator Providing the Training ip�UND, STORAIGE TANK COPERATOR INFORMATION <br /> Zane Nimmo - <br /> F41 <br /> Address -- - --� _ <br /> nd Street Galt CA 95632fn ° r' uatic�n - - — (209 ) 744 - 0112 <br /> 8883064 - UC ICC Certification Expiration Date 2 /25 / 2020 <br /> y_IIS FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employee before October 13 , 2018 must be trained within 30 days of performing <br /> facility employee duties . Individuals assuming the duties of the facility employee on and after October 13 , 2018 must be trained <br /> before performing facility employee duties . <br /> Check this box if a list of the individual(s) trained is appended to this form. The appended list, at a minimum, must contain <br /> all of the information in this section . <br /> Date of Assuming <br /> Name of Individuals ) Trained Initial Training Date Responsibility as a <br /> Facility Employee <br /> fz6�z / 9 <br /> W r�> "A VL Q 6 <br /> i <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING j <br /> The facility employees listed above have completed the required training in accordance with California Code of Regulatior <br /> Title 23 , Division 3 , Chapter 16 , Section 2716 ( c ) and all the information provided herein is accurate . <br /> opera <br /> Signature Dale of Trail ' Ig <br /> Training Designated UST Op l <br /> MIN <br /> CERS = California Envi <br /> ronmental Reporting System, ID = Identification, ICC = International Code Council, UST = Undergramd Storage Tank <br />