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UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (page 1 of 2) <br /> I . FACILITY INFORMATION <br /> CERS ID Date of Designated UST Operator Inspection <br /> 10182257 6/7/2019 <br /> Business Name (Same as Facility Name or DBA-Doing Business As) <br /> WINE COUNTRY 76 <br /> Business Site Address City ZIP Code <br /> 1111 E . KETTLEMAN LANE L O D I 195240 <br /> II . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Print as shown on the ICC Certification.) Phone # <br /> Zane Nimmo (209 ) 744- 0112 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8883064- UC 2/25/2020 <br /> ) II. COMPLIANCE ISSUES <br /> All answers of "N" or NA " in sections Vil through XI must be explained in this section and may require follow-up action. <br /> 1 . L - 4 CONSTANT ALARM NEEDS HELP , NO CONTRACTOR FIGURED OUT ISSUE . <br /> 2. ANNUAL TESTING THIS MONTH MAY BE ABLE TO REPAIR WITH TESTING . <br /> 3 . <br /> 4 <br /> --- <br /> 6 . _v - <br /> - <br /> 92 <br /> 10. <br /> 12 . THIS SITE IS DOUBLEWALL TANKS AND LINES AND DOES NOT REQUIRE TESTING , <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> 1 hereby certify that the visual inspection was performed in full compliance with California Code of Regulations , Title 23 , <br /> Division 3, Chapter 16, Section 2716 and all the information provided herein is accurate. <br /> Designated UST Operator Signature 0 <br /> V. OWNER / OPERATOR DESCRIPTION OF FOLLOW-UP ACTIONS <br /> All issues listed in Section 111 above must have a description of the follow-up action taken or to be taken to correct the issue on the number <br /> line that corresponds with the number line of the compliance issue listed above in Section lll. <br /> 1 . <br /> 2. <br /> 3 . <br /> 4. <br /> .e. <br /> 5 . <br /> 6 . <br /> 7. <br /> 8 . <br /> 9 . <br /> 10 . <br /> 11 . <br /> 12. <br /> VI . OWNER OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> I have reviewed Section III "COMPLIANCE ISSUES " and provided a description in Section V of the action taken or to be taken <br /> to correct the issues discovered . <br /> Name of UST Owner/Operator (Print) UST Owner perator Sjgnature Date Sig ed P <br /> vvj 41 14 IYC <br /> CERS = Cardomia Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council <br /> a <br />