Laserfiche WebLink
0 <br /> 171) <br /> Q) <br /> 0) <br /> cis <br /> U) <br /> E <br /> cz <br /> 0) <br /> 0 <br /> a <br /> FACILITY EMUNDERGROUNDSTOR <br /> PLOYEE TRAINING CERTIFICATE(Page 1 ail <br /> Business Name(seas es F-ady Ne me or Deq- I FACILITY INFORMATION <br /> Pacific AVenueChevron °O'npBus1ne"aai <br /> Business Site Ad... CERS ID <br /> ay 6633 Pacific Avenue 10594654 <br /> }y ZIP C°tle <br /> If. DESIGNATED UNDECayRGROUND STORAGE TANK OPERATOR INFORMATION ockton 95207 <br /> •i—I Name of Deaipnatetl UBT Opealor Paulding the Training(Print ea shown on Ne ICC CertigceponJ <br /> Michael Reimers/Stephanie Murphy(209-380-5542) <br /> Mailing Aedasa <br /> PO Box 1096 Carmichael CA 95609 <br /> 4--1 'cc Cenm°auon u 916)967-2279 <br /> 6/ Icc oenmcat on Expiation Daca <br /> 0 828927 8/20/2020 <br /> 0 111. FACILITY EMPLOYEE INFORMATION <br /> individuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing <br /> facility employee duties.Individuals assuming the duties of the facility employee on and after October 13,201 B must he trained <br /> hrhotore performing facility employee duties. <br /> `-' all of Theis box ffa list <br /> In this secifon <br /> individual(s)trained Is appended to this form.The appended list,ata minimum,must contain <br /> Dale of Assuming <br /> Name of Individual(s)Trained Initial Training Date Responsiblliry se a <br /> Facility Employee� <br /> Feb nrD <br /> my q/& <br /> 7:1 Dara <br /> � � okolrCb 1►� 2s� <br /> CD cd <br /> O <br /> L <br /> rn � <br /> U � <br /> 0 <br /> o U) <br /> U U _ <br /> 0 (Lf W <br /> U W <br /> 0) W <br /> J <br /> Q <br /> N. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING � <br /> U z <br /> U N M The facility employees listed above have completed the required training In accordance with California Code of Regulatlorte, .l Q <br /> M O O Title 23,Division 3,Chapter 16,Section 2715(c)and all the information provided herein is accurate. > <br /> •.-r Date of Training <br /> M M Tminin ated r r Signature n !I J11 <br /> c') <br /> = L) <br /> CD <br /> L L`J <br /> CO O a ..e.,,.,.,,,manlal Rerorli ID=ldengm§On,ICC=kenieBptlal Code CaundI,UST-Urdelground StorageTank > <br />