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RECEIVED BY SJC EHD (EF) ON 7/9/2021 <br /> UNDERGROUND STORAGE TANK <br /> 7= FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1) <br /> I. FACILITY INFORMATION <br /> Business Name(Same as Facility Name or DBA-Doing Business As.) CERS ID <br /> WATERLOO LIQUOR <br /> Business Site Address City ZIP Code <br /> 2512 E WATERLOO RD � STOCKTON 95205 <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training(Print as shown on the ICC Certification.) <br /> DAVID MARTIN <br /> Mailing Address Phone# <br /> 1100 N J ST. TULARE CA 93274 559 688 - 2977 Ext. <br /> ICC Certification# ICC Certification Expiration Date <br /> 5246124-uc 8/29/2022 <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 facility <br /> employee duties. Individuals assuming the duties of the facility employee on and after October 13,2018 must be trained before performing <br /> facility employee duties. <br /> ® Check this box if a list of the individual(s)trained is appended to this form. The appended list at a minimum must contain all of the <br /> information in this section. <br /> Initial Training Date Date of Assuming <br /> Name of Individual(s)Trained Responsibility as a <br /> Facility Employee <br /> .Zl <br /> *1/t,uC) ? 2 -'q,Z <br /> �In Zt , z <br /> david turner 8788650-uc a signature <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 the information provide herein is accurate. <br /> Training Desi ed UST OperatQr Si Date of Train' g <br /> 7/7 a,/ <br /> CERS=Califomia Environmental Reporting Systems,ID=Identification,ICC=International Code Council,UST=Underground storage tank <br />