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UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1 ) <br /> I . FACILITY INFORMATION <br /> euq=ss Name (Same as Facility Name or DBADoinq Business As) CERS I / <br /> rz Q � 0 <br /> Business Site Address City ZIP Code <br /> �5 y o .civ Jl b 1 c COO,) <br /> II . DESIGNATED UN ERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training (Print as shown on the ICC Certification.) <br /> Zane Nimmo <br /> Mailing Address Phone # <br /> 416 2nd Street Galt CA 95632209 744- 0112 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8883064 - UC 2/25/2020 <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 individuals) trained is appended to this form. The appended list, ata minimum, must contain <br /> 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 /> Z vU � <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 Designated UST Operator Signature Date of Traini <br /> —.eQ 40f <br /> CERS = Califomia Environmental Reporting System, ID = Identification, [CC = International Code Council, UST = Underground Storage Tank <br />