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2680 Reynolds Ranch Parkway PR0535432 <br /> May 18, 2021 Program: UST <br /> PHOTO 1: D. O. re ort without alarms included in section 3. <br /> Appendix XIII <br /> Desi Underground Storage Tank <br /> Designated UST Operator visual Inspection Report <br /> 1• <br /> FACILITy INFORMATION <br /> CERS Ip <br /> 79746767 Inspection Date 0611312021 <br /> Facility Name <br /> Costco Wholesale-LOIN-7097 <br /> Facility gddress City ZIP Code <br /> 2680 Reynolds Ranch Pkwy Lod. 6240 <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone <br /> Gabriel Martin (949)460.6200 <br /> ICC Certification Certification Expiration Date <br /> 8260320 661612022 <br /> 3. COMPLIANCE ISSUES <br /> I <br /> I <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> 1 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 U T erato Si g�y re Date Inspection Report Provided to Owner <br /> I 05/13/2021 <br /> 1 CERS=California Environmental Applicable,UDC Reporting Under-Dispenser Containment UST Council,Underground <br /> Identscation,NA=Not Applicable, <br /> • <br /> Storage Tank <br /> Page 1 of 4 <br /> Lydia Baker, SR. REHS Page 1 of 3 <br />