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Appendix XIII <br /> Underground Storage Tank <br /> Designated LIST Operator Visual Inspection Report <br /> 1 . FACILITY INFORMATION <br /> GERS ID 10181431 Inspection Date 10/14!2020 <br /> MI <br /> Facility Name Valero <br /> Facility Address City ZIP Code <br /> anteca 195336 <br /> 1700 Yosemite Ave <br /> M <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> E <br /> f Designated UST Operator Phone <br /> o Arnaiz (209) 518 =4836 <br /> tification Certification Expiration Date <br /> 2/3/2021 <br /> 3. COMPLIANCE ISSUES <br /> 1 . No record on site of overfill prevention testing ever being completed , <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 /> De ign t d UST O ator, ignature Date Inspection Report Provided to Owner <br /> 10/14/2020 <br /> CERS = Californi nvironmental Reporti S tem , ICC = International Code Council , ID = <br /> Identification , NA = Not Applicable , UDC = er ispenser Containment , UST = Underground <br /> Storage Tank <br /> UN-111 <br /> www.unidocs.org Rev. 10101 /20 Page 1 of 4 <br />