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4219 E. Morada Ln, Stockton, Ca 95212 PRO524617 <br /> 07/07/2021 Program: UST <br /> PHOTO 1: <br /> 1/4/21 onthl desi nated o erator report identifying compliance issues <br /> Appendix XIII <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 1. FACILITY INFORMATION <br /> CERS ID 10185183 Inspection Date 01/04/21 N <br /> Facility Name Aisle 1 2356 F <br /> City ZIP Code � <br /> Facility Address 95212 <br /> 4219 Morada Ln Stockton <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone (408)971-2445 <br /> Rita Martinez <br /> Certification Expiration Date <br /> ICC Certification 11/15/22 <br /> 9028811 <br /> 3. COMPLIANCE ISSUES <br /> Identify by number all compliance issues listed <br /> TLS CURRENTLY ALL FUNCTIONS NORMAL <br /> SB-989,TANK/LINE TIGHTNESS TESTING NOT REQUIRED <br /> PROVIDED TRAINING TO KATRINA FLIPPULA AND SAMMY THANPAENG. <br /> L 3 REGULAR STP BRINE STP SUMP FUEL ALARM <br /> 12/29/20 SSS JOB 390421 <br /> 12/27/20 SSS JOB 390421 <br /> 1)NEED TO REMOVE LIQUID FROM DIESEL SPILL BUCKET*"* <br /> 2)NEED TO REPLACE THE DIESEL FILL CAP*" <br /> i <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 US IP� <br /> �ture Date Inspection Report Provided to Owner <br /> 01/04/2021 <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 /> VICKY VANG-LEE, EHS Page 1 of 2 <br />