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900 S Cherokee Ln, Lodi, CA 95240 PR0231841 <br /> 10/27/2021 Program: UST <br /> PHOTO 1: <br /> Amy Winkler started conducting the monthly inspections on 07/21/2021 but she has not been reported in CERS <br /> Appendix XIII <br /> No NA <br /> Date last In 9 ated Underground Storage Tank <br /> performed 1'FACILITY INF UST Operator Visual Inspection Report <br /> ❑ 10-15-2020 CERS ID 10 <br /> 18 <br /> 0627 M, I ON <br /> ❑ 10-15-2020 <br /> Facility NameCHEROKEE GAS&MART-ARCO <br /> Inspection Date 7121121 <br /> Facility Address S CHEROKEE LN Zi Code 95240 <br /> ❑ ❑ 01-18-2021 2.DESIG City LODI P <br /> NATED UST OPERATOR INFORMATION <br /> ❑ ❑ 10-22-2018 Name of Desi <br /> gnated UST Operator Amy Winkler Phone 209-744-0112 <br /> ❑ ICC Certification 9951352-UC <br /> Certification Exp Date 312612023 <br /> ❑ 3•COMPLIANCE ISSUES <br /> El Identify by number all compliance issues listed <br /> 7 ❑ _ I <br /> Yes N. <br /> Jlty IR ❑ <br /> 1t compliance <br /> i <br /> I <br /> i <br /> i <br /> 4.CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> I hereby certify that the visual inspection was performed in compliance with California Code <br /> of Regulations,title 23,division 3,chapter 16,section 2716 and all information provided <br /> herein is accurate. — -- <br /> Designated UST Operator Signature Date Inspection Report Provided to Owner <br /> – 7121121 <br /> ICC=International Code Council, <br /> CERS=California Environmental ReportingUndereDispenser containment,UST Underground <br /> Identification, NA=Not Applicable,U <br /> ;tion 3. Storage Tank <br /> Page 1 of 4 <br /> Page 4 of 4 <br /> VICKY VANG-LEE, EHS Page 1 of 4 <br />