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1225 W. Lockeford St, Lodi, CA 95240 PR0231350 <br /> 11/23/2021 Program: UST <br /> PHOTO 8: <br /> 11/12/2021 designated operator(DO) monthly report has incorrect overfill prevention test date <br /> Appendix x111 Underground Storage Tank <br /> �•§AcUnderground Storage TankDIiy I�ostgnated UST p Designated UST operator visual Inspection Report <br /> RM-rator Ysual Inspection Report <br /> Facility Nam Date last <br /> p 1e 181373 Inapectlon Date 11/122021 10. TESTINGS AND MAINTENANCE Yes No NA <br /> acillty LODI Fn Performed <br /> Address a'LIQUOR <br /> 2, O 225 w lockeford st Has monitoring system certification been completed within the past ❑ 1112512020 <br /> ESIGNgTED UST C ZIP COQ777� 12 months? <br /> 10di 95240 ❑ 1112512020 <br /> Ne OPERATOR INFORMATION Has spill container testing been completed within the past <br /> Edward St.msgnated UST OPWator <br /> 12 months? <br /> 888 080 uiflCcation Ph°ro Has overfill prevention equlpment Inspection been completed wlthln [02 ❑ t1/�1120;18 <br /> zoeaaa of t z <br /> 3• COMPLIA Certifim on Expiration Date the past 36 months? <br /> id NCE Issue, y27"22 Has secondarycontainment testing been completed within the past Td ❑ ❑ 212612020 <br /> sn by nGm¢er all compNsnce Issues listetl Y'l <br /> TANK AND LINE T 36 months? <br /> REQUIERD EsrINc NOT Has tank tightness tasting been completed within required ❑ ❑ <br /> timeframes? <br /> Has line tightness testing been completed within the required 0 ❑ lc�t <br /> timeframes? E3 U JU <br /> Other Test/Maintenance: <br /> IOther Test/Maintenance: ❑ ❑ <br /> Other Test/Maintenance: " ® E3 0 <br /> I, 11. FACILITY EMPLOYEE TRAINING Yes No <br /> Have all individuals performing facility employee duties received the required facility �+- <br /> employee training within the past 12 months? <br /> 13. COMMENTS <br /> This section may be used to record comments or observations that are not current compliance <br /> deficiencies. <br /> 4. CERTIFICATION BY DESIGNATED USfi ORftATOR cQNDUCTING IN$pECTION <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 /> esignated UST Operator Siqnature Date Inspection Report Provided to Owner <br /> v 11/12/2020 <br /> =calif,,;,Environmental Reporting System,ICC=International Code Council,ID= <br /> iiiiiiiiiiiir ade&cation,NA=Not Applicable,UDC=Under-Dispenser Containment,UST_Underground , <br /> Storage Tank �. <br /> Page 1 of 4 <br /> /answers marked No"must be described by the designated UST operator in Section <br /> VICKY VANG-LEE, REHS Page 8 of 8 <br />