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ol <br /> RECEIVED <br /> By Carol Presto at 12:08 pm, May 13, 2021 <br /> UNDERGROIJNC]STORA <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE !page 9 of 1) <br /> "� Business Name(Same as FaclhtyName or p13A-Doing Business FACILITY INFORMATION <br /> Quik Stap Market# cE�s I❑ <br /> Business Site Address /0180893 <br /> 3555 W. Hammer Lane City Z P Codo <br /> Stockton 95219 <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of pesignated i15T t?peralor Providing lhE Training(Prrnl as shown on the ICC CaKillCatian-J <br /> Anthony Reyes <br /> Mailing Address <br /> P.0 Box1025, West Sacramento, CA, 95691 �hcne# <br /> 1CC CBrtlfiCil ll0n# ICC G,nl[lcalion Expiration dale {9 16) 372-1888 <br /> 8293772 11/20/2021 <br /> Ill. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employoo before October 13,2018 must be trained within 30 days of performing <br /> facility employee duties.Individuals assuming the duties of the facility,mplayde oil and aftor October 13,2018 must be trained <br /> before performing facility arnployee duties, <br /> ❑ Check this box if a list of the Individual(s)trained is appended to this Faral. The appended list ata minimum,must contain <br /> all of 1110 information In this section. <br /> Name of Indlvldual(sy Trained - Date of Assuming <br /> Initial Training Date Responsibility as a <br /> Facllity Employ,, <br /> Yi <br /> Fn <br /> 1V. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The facility employees listed above have completed the required training In accordance with California Code of Regulations, <br /> Title 23,Division 3,Chapter 16,Section 2715(c)and all tho information providod herein is accurate. <br /> Traing Designated U r pperatnr 5lgnature <br /> 'j <br /> ❑ate,f Training <br /> 4/25/2021 <br /> CERS-Califnmio al ftepoiGng System,I =Ider0fra6on.ICC=Inlernatlonal Code Council UST-UrdOrgroueld Storage Tank <br />