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Appendix Xlil <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 1 . FACILITY INFORMATION <br /> CERS ID 10132636 Inspection Date 7 - 07 -2021 <br /> Facility Name FLYERS 487 <br /> Facility Address City ZIP Code <br /> 983 MO [* FAT BLVD MANTECA 195336 <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone <br /> CLENT GAGNIER 534 -521 =6818 <br /> ICC Certification Certification Expiration Date <br /> 5243792` 10-&2022 <br /> 3 . COMPLIANCE-" ISSUES <br /> Identify by number all compliance issues listed <br /> ANNUAL. MONITOR CERT AND SPILL BUCKET TESTING IS DUE BY JULY 31 , 2021 <br /> (CURRENTLY STILL IN COMPLIANCE) <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 /> Designated UST Operator Signature Date Inspection Report Provided to Owner <br /> CERS = California Environmental Reporting System , ICC = International Code Council , ID <br /> Identification , NA = Not Applicable , UDC = Under- Dispenser Containment , UST Underground <br /> Storage Tank <br /> Page 1 of 4 <br />