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141 E Harney Ln, Lodi, CA 95240 <br />08/18/2021 <br />PHOTO 12: <br />PR0543574 <br />Program: UST <br />Taranjit Singh, has not been trained. <br />UNDERGROUND STORAGE TANK <br />FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1) <br />I. FACILITY INFORMATION <br />Flusines/s f/aloe (Same as Facr/hfy Name or OBA�Doi Business As) CERS ID <br />susin� $itg Addraee Ciry <br />/ / ZIP Code <br />c <br />It. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br />PNaMof Designated UST Operator Providing the Training (Print as shown on the ICC CAddressBox 933, West Sacramento, Ca 95605 rtification# /hi�fpICC Cedifcation Expiration Date 916 371-2380 <br />�/ • � 7 • � <br />III. 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, 2018 must be trained <br />Individuals <br />performing facility employee duties. <br />Check this box ifa list of the individualls) trained is appended to this form. The appended list, at a minimum, must contain <br />all of the information in this section. <br />Name of Individual(s) Trained Date of Assuming <br />Initial Training Date Responsibility as a <br />Facility Employee <br />MG ✓A <br />Ak <br />Z?ps tie <br />.- <br />.......onai uoee counal, UST = Unde <br />rground Storage Tank <br />VICKY VANG-LEE, EHS Page 12 of 18 <br />