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900 S Cherokee Ln, Lodi, CA 95240 PR0231841 <br /> 10/27/2021 Program: UST <br /> PHOTO 2: <br /> The owner/o erator failed to provide date of signature ( a e 1 of 2) <br /> ,rage Tank <br /> ;ual Inspection Report F 00signated Under A►o�nd Storage ndix XIII <br /> Tank <br /> Yes No NA Date OERSCID ITy INFORTION UST Operator Visual Inspection Report <br /> perform Facility Na 0180627 <br /> hin the past me Inspection Date 01-04-2021 <br /> ❑✓ ❑ 10/15/2020 900 ility Address HEROKEE ARCO <br /> t ❑ 10/15/2020 S CHEROKEE LANE Zip Code <br /> 2. City 95642 <br /> Na bESIC,�TEp UST OPERATOR INFORMATION LODI <br /> 'ted within ❑ ❑ 1/18/2021 h1e of <br /> the past ❑ ❑ ❑ iCuc RamireersIgnated UST Operator phone <br /> 10/22/2018 g8g Certification 209-744-0112 <br /> 3072-uC <br /> ❑ ❑ ❑✓ 3 C Certification Expiration Date <br /> OMPLIANCE ISSUES 3/1/22 <br /> d ❑ ❑ Identity by number <br /> alt compliance issues listed <br /> O TANKS OR LINE TESTING NEEDED <br /> ❑ ❑ ❑✓ <br /> Y No <br /> J the required facility <br /> iat are not current compliance <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> 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 /> esignated UST Ignature Date inspection Report Provided to Owner <br /> 01-04-2021 <br /> CERS=California Environmental Reporting System,ICC=International Code Council,ID= <br /> rator in Section 3. Identification, NA=Not Applicable,UDC=Under-Dispenser Containment,UST=Underground <br /> Storage Tank A t <br /> VICKY VANG-LEE, EHS Page 2 of 4 <br />