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ZO UNDERGROUND STORAGE TANK FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1 ) I . FACILITY INFORMATION Business Name (Same as Facility Name or DBA-Doing Business As) CERS ID City of Stockton CORP Yard 10181525 Business Site Address City I ZIP Code 1465 S . Lincoln Street Stockton 195203 II . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION Name of Designated UST Operator Providing the Training (Print as shown on the ICC Certification.) Karen R Arnaiz Mailing Address Phone # P . O Box 162 Lodi , CA . 95241 (209) 5184836 ICC Certification # ICC Certification Expiration Date 8032295 2/3/2021 III . FACILITY EMPLOYEE INFORMATION Individuals assuming the duties of the facility employee before October 13, 2018 must be trained within 30 days of performing facility employee duties . Individuals assuming the duties of the facility employee on and after October 13 , 2018 must be trained before performing facility employee duties . Check this box if a list of the individual(s) trained is appended to this form. The appended list, at a minimum, must contain all of the information in this section. Date of Assuming Name of Individual (s) Trained Initial Training Date Responsibility as a Facility Employee 30 tl ct. 3 2 13 1 111 ;V e� 1*7 4 03 I mt K I 3 z5 - 13 9 W, 13 1 0 UI 1iL V 12 (ATC0)A0hX 415 IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING The facility employees listed above have completed the required training in accordance with California Code of Regulations, Title 23, Division 3, ,Chapter 16 , Section 2715( c) and all the information provided herein is accurate. Training Designated .0ST Operator Signature Date of Training I. 3/21 /2019 CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council, UST = Underground Storage Tank