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M _< -U4�- � <br /> N <br /> O = N v <br /> 7 N <br /> -n ir Z3 ON O <br /> 0 IN) <br /> O Np �. <br /> W <br /> o DESIGNATED O <br /> UNDERGERGROUNDSTORAGETANK O <br /> Z7 CERS ID ROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT(Page 1 of 2) CD N <br /> M !. FACILITY INFORMATION cri <br /> � <br /> Business Name Date of Designated UST Operator Inspection 7 <br /> no as F <br /> p� N <br /> WATERLOO' UO 'no-01'A_ <br /> -I 6-25-2020 <br /> RS NaDa' Cp Ill <br /> Business 8ifo Business As.) Q <br /> Address <br /> 2592E o <br /> WATERLOO RD city zrP Code _ <br /> ' Name of II' DESIGN STOCKTON <br /> m m <br /> Designated UST Operator p gTBD UNDERGROUND-STORAGE TANK OPERATOR INFORMATION O <br /> DAVID MARTIN (Pil as shown on etre ICC Certrrrcation.) 0 0 <br /> fCC Certifi Phone# 70 <br /> 5246924-LJC# (559)688-2977 Ext- tp Q <br /> tCC Ceditication Expiration Date O <br /> 9-30 2020 o <br /> All answerofN"or N4"rn III. COMPLIANCE ISSUES O n <br /> 1 sections Vtt through Xr must be explained in this secLon and may require follow-up action. � � <br /> 2. m O <br /> 3. m <br /> 4, o D <br /> 5, m <br /> 6. <br /> CD <br /> 7. tz <br /> 8. 07 <br /> 9. <br /> 10. CD <br /> 0 <br /> 11. _ <br /> 12. _ m <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION _ <br /> 1 hereby ce - 3 <br /> division 3, ha that the casual inspection was performed in fu!!compliance with California Code of Regulations,title 23, <br /> oho ter 76,section 2716 an all the inform on provided herein is accurate. <br /> Designated US C <br /> pera[or Sign e _ CD <br /> V. OWNER/OPERATOR DESCRIPTION OFF <br /> Atl resue listed in section!t!above,most have a descnphon of the follow-u OLLOW-UP ACTIONS <br /> corresponds with the number tine the Compliance issue is listed above in section fll. CD <br /> p action taken,-to be taken,to correct the issue an the number line that <br /> 2. — 3 <br /> 3. — CD <br /> 4. v <br /> 3 <br /> 5. — � <br /> 6. <br /> 7 <br /> 8. <br /> 9. <br /> 10. ` <br /> 11. ` <br /> 12. ` C) ;U <br /> ` C0 <br /> V1. OWNER I OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> DQ <br /> I have reviewed section c "COMPLIANCE ISSUES"and provided a description in section V,of the action taken or to he taken <br /> to correct the issues discovered. � C � <br /> Name of UST Owner/Operator(Print) Cn -u <br /> USTOwnerlOperalor5ignature � �J <br /> Hate Signed <br /> � W <br /> N � N <br /> CQ � <br /> CD � <br /> tb <br /> 0 <br />