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1225 W. Lockeford St, Lodi, CA 95240 PR0231350 <br /> 11/23/2021 Program: UST <br /> PHOTO 5: <br /> 07/21/21 designated operator(DO) monthly report has incorrect over 11 revention test date <br /> unuergrourld Storage Tank <br /> Appendix XIII e5lgnated UST Operator Visual Inspection Re <br /> signate Underground Storage Tank POtt <br /> d UST Operator Visual Inspection Report INTENANCE <br /> I ATION p MA <br /> Facie lu 10181013 ��,Yotlo <br /> ertification been completed withintepastYe$ No NA Datelast <br /> tY Name LODI FOOD Inspection Date 7/21/21 ❑ f�elfOrrr>Ld <br /> a uouoR 19 rtestin9 been completed within the past 112 pII <br /> Facility Address 1225 W LOCKEFORD ❑ 520 <br /> 2•DESIGNATED UST OPE city LODI ip Code 85240 ,^lame ❑ - <br /> BATOR INFORMATIONuipme <br /> equip <br /> inspection been completed within <br /> Name of Desig __ 112520 y U81 I, <br /> ed natUST Operator Am ypt12 <br /> ICC Certification m0e Y Winkler Phone ..Pre teh5g been completed with ❑ ❑ ❑ 1121118 <br /> 9951352-UC Certification Exp Date 3/26/2023 � talnnlent testing in the past <br /> n <br /> 3.COMPLIANCE ISSUES I2r� ❑ ❑ 2126120 <br /> Identify by number all compliance issues listed ? s testing been completed within required ❑ ❑ ✓ <br /> I9ptoes o. <br /> �1 pI��L Sump 5? been completed within the required ❑ ❑ ✓❑ Lo[ <br /> •�pteess testing <br /> P q <br /> ael aintenance: ❑ ❑ ✓ <br /> 2sl Maintenance: <br /> astlmaintenance: ✓ Yes No <br /> rCiLi01 OYEE TRAINING ❑ ❑ <br /> IliadVll duals Performing facility employee duties received the required facility <br /> within the past 12 months2 <br /> ,,training <br /> S Nance <br /> l,MMNET <br /> section maybe used to record comments or observations that are not current comp <br /> cies. <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�ST_Operator Signature Date Inspection Report Provided to Owner <br /> 7/21121 <br /> C� - <br /> Environmental Reporting <br /> UDC Under-Dispenser Containment,nment UST Underground <br /> Identscation,NA=Not App <br /> Storage Tank Page 1 of 4 <br /> VICKY VANG-LEE, REHS Page 5 of 8 <br />