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SOUND STORAGE TAW, <br /> FC7ERSID <br /> ED UNDERGROUND:STORAGE TANK OPERATOR VISUAL INSPECTION REPORT t:of 2 <br /> I: FACILITY INFORMATION <br /> Date of ignatedUST9nerator Inspection <br /> Business Name(same as Facility Name or DBA-Doing Business As) <br /> Sunwest Chevron <br /> Business Site Address City ZIP Code <br /> 2758 W. Kettleman lane. Lodi 95242 <br /> a. ;:DESINATED MDERGROUND STORAGE TANK OPERATOR INFORNtATION <br /> Name of Designated USTOperatgr-(Prirj1as shown on the ICC Certifrcation.) Phone# <br /> ICC Certification ICC Certifi tion E*piratioll Date <br /> III. COMPLIANCE.ISSUES <br /> All answers of`N'or` Win sections Vll through Xl must be explained.0 this sectionjand may require follow-up action. <br /> 2. _ " - <br /> 3. <br /> 4. <br /> 6. <br /> 7. <br /> 8. <br /> 9.- <br /> 10. <br /> -12. <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> ......... . . <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 i <br /> x ' <br /> V. OYMER I OPERATOR DESCRIPTION OF.FIJLLOWWW-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 ill. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. -- — <br /> 8. <br /> 9. <br /> 10. <br /> 11. <br /> 12. <br /> VI. OWNER i 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/Operator Signature 77iK�:] <br /> CERS=Caifrx m Ernvaimental Reporting System,ID=Identification,UST=Underground Storage Tank,ICC=International Code Coundl <br />