Laserfiche WebLink
cY) <br /> 4- <br /> 4 O <br /> �N�+ N <br /> r 0) <br /> i) <br /> 'C (D <br /> U) a+ <br /> N <br /> i� <br /> Nr�I <br /> O <br /> 3~ <br /> N <br /> s•, <br /> N <br /> N <br /> N <br /> O <br /> >-1-i <br /> N <br /> N <br /> v� PSA°iT <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(Peg-1 or t) <br /> Ut'1 I. FACILITY INFORMATION <br /> '� Fscr Business NZ,,(S,,.es Feali,y Nameor DBA-Doing Business As) CERS ID <br /> Pacific Avenue Chevron 10594654 <br /> ty Bualness SileAddress ciy ZIP Calle <br /> ��•i em fir. 6633 Pacific Avenue Stockton 95207 <br /> ll. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> O Name or--signaled UST operator P—aing the Training(PMI as shown on fhe ICC Canificafion) • <br /> s- Stephanie Murphy Phone• <br /> Nailing Address 209 380-5542 <br /> CC n <br /> t Box 6 Carmichael CA 95609 ICC Cenifim o Expiration Date <br /> 10/1/2021 <br /> 9383552 <br /> ,ma�y-r 111. FACILITY EMPLOYEE INFORMATON erfonning • <br /> .+•I Individuals assuming the duties of the facility employee before October 1312118 must be trained within 320 a must be trained <br /> �..i facility employee duties.Individuals assuming the doges oT the facility employee on and aker Oelober 13, <br /> $•-I before performing facility employee duties. <br /> �..ided to this 1,The appended list,ata minimum,must contain <br /> 1+0Check this box Ira listofthe individuals)trained is appan <br /> M ❑ all of the information In this section. Data of Assuming <br /> to <br /> Int'-IT iningDate Rasponslbility ase <br /> Name of Individual(s)Trained Facility Employee <br /> :1 Shalande'L Johnsor. <br /> "� <br /> a Ids a -ao \1.1 DID <br /> S1 11—L Zp2m —lU <br /> CD C1 <br /> CD <br /> N r <br /> Lf') � <br /> lD <br /> O <br /> � o � <br /> U U T— <br /> o <br /> O W <br /> U W <br /> LU <br /> �F J <br /> Q <br /> Title ryz <br /> `- U Y DESIGNATED UST OPERATOR CONDUCTIING THIS TRAINING <br /> N , trainingted the required California Code of Reguletlons, Q <br /> OO The <br /> icemployees <br /> listed <br /> abta27151c)Ive end all the nformaGonp provided herein Is ac rate > <br /> 23, 3, 5ecIon <br /> Dale of Training <br /> M Q Training '9nate0 ST Operator Signature 2� Y <br /> co � U <br /> f9 CD n lnfemzoonal Cade Cana$UST=Underground SivageTM* > <br />