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111 ... rC -- <br /> � 1G TAC-OPERA.. .. _ <br /> TOR l AL <br /> _ f FACi `Y - <br /> 1' <br /> CERS ID <br /> 10748068 Date of Des!Rnatea OF rator Inspection <br /> Business Name(Same as Facility Name or DBA-Doing Business As) <br /> Sunwest Chevron <br /> Business Site Address <br /> 2758 W. Kettleman lane city ZIP code <br /> Lodi 9 <br /> >✓! lGNATEU tDH GROUND�F OPERAT'OW . . <br /> Name of Designated EAST operatoy(Pri as shown on me lCC Certrfrcation. GE TkpK 42 <br /> Phone# <br /> ICC Certification <br /> ICC Certifi on�E�Cpiratiojt Date <br /> i � <br /> All answers of-N.—r C��E'ISSt3Eg_ <br /> A'in sections Vll through X/must be explained P this sectionland may require follow-up action. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> 11. <br /> 12. <br /> _: CER7•#F11CIk�1�g�lQ <br /> � Tft USTI;3PERAT# 2. arm:THI�t <br /> I hereby certify that the visual inspection was p <br /> Division 3,Chapter 16,Section 2716 and-,all the information providcompliance <br /> herein is a��elrfornia Code of Regulations, Title 23, <br /> Designated UST Operator Signature r�i <br /> OPE# TR.D1cSCR�POi�i flF F _ <br /> All issV. <br /> ues fisted rn Section 11l above must have a description of the follow-up action taken bye taken toC��g issue on the number <br /> line that correspo s wilh the number lrne of the compliance issue listed above in Section lil. <br /> 1. / �= <br /> Z. <br /> J. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> t0. <br /> 11. <br /> 12. <br /> L JIM ER t OPfR ETOR,4C . <br /> I have reviewed Section 111"COMP EDGNF-MF OF COMP <br /> LL4NCE ISSUES"and rovided a description in Section e a ken or to be taken <br /> to correct the Issues discovered. <br /> Name of UST Owner/Operator(Print) <br /> UST Owner/pperator Signature <br /> Date Signed <br /> CERS=Caffww Ertveonn <br /> R r9 Sys>Em,ID=td UST=Undwgil rid Sbxage Tank K:C=hteMatlOn2i Code Courrji <br />