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1 <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of i ) <br /> I . FACILITY INFORMATION <br /> Business Name (Same as Facility Name or DBA-Doing Business As) CERS ID <br /> City of Stockton CORP Yard 10181525 <br /> Business Site Address City ZIP Code <br /> 1465 S . Lincoln Street Stockton 95203 <br /> 11 . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training (Print as shown on the ICC Certification.) <br /> Karen R Arnaiz <br /> Mailing Address Phone # <br /> P . O Box 162 Lodi , CA . 95241 209) 518 -4836 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8032295 2/3/2021 <br /> III . 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 /> El all of the information in this section. <br /> Date of Assuming <br /> Name of Individual (s) Trained Initial Training Date Responsibility as a <br /> Facility Employee <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 provided herein is accurate. <br /> Training Designaljgd UST Operator Signature Date of Training <br /> 3/21 /2019 <br /> CERS = Cal fornia Environmental Reporting System, ID = Identification, ICC = Intemational Code Council, UST = Underground Storage Tank <br />