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200302- 280 <br /> UNDERGROUND STORAGE TANK <br /> FDESIGNATED <br /> UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1 of 2 ) <br /> 1 . FACILITY INFORMATION <br /> S Date of Designated UST Operator Inspection <br /> 10141507 04/21 /20 <br /> Business Name (Same as Facility Name or DBA-Doing Business As) <br /> Manteca CO <br /> Business Site Address Citv ZIP Code <br /> 430 W . Center Street Manteca 95336 <br /> II . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Print as shown on the ICC Certification . ) Phone # <br /> Kraig Kinder ( 888 ) 588- 8737 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8296393 12/07/20 <br /> III . COMPLIANCE ISSUES <br /> All answers of "N" or WA " in sections VII through XI must be explained in this section and may require follow-up action. <br /> 1 . N/A : Emergency generator location . No under dispenser containment . <br /> 2 . N/A : Tank Tightness Testing- Secondarily Contained <br /> 3 . N/A : Line Tightness Testing-Secondarily Contained and is a suction system . <br /> 4 . <br /> .5 <br /> - <br /> 5 <br /> 7 . <br /> 8 . <br /> 9 . <br /> 10. <br /> 11 . <br /> 92. <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS INSPECTION <br /> I hereby certify that the visual inspection was performed in full compliance with California Code of Regulations , Title 23 , <br /> Division 3 , Chapter 16 , Section 2716 and all the information provided herein is accurate . <br /> Designated UST Operator Signature Og"hy s+9^ed by Kraig Kindel <br /> Kraig KinderOoaera2020012, 0909 , , <br /> V. OWNER / OPERATOR DESCRIPTION OF FOLLOW- UP ACTIONS <br /> All issues listed in Section 111 above must have a description of the follow-up action taken or to be taken to correct the issue on the number <br /> line that corresponds with the number line of the compliance issue listed above in Section 111. <br /> 1 • Confirmed no follow-up action necessary. __- <br /> 2 • Confirmed , no follow-up action necessary_ <br /> 3 . Confirmed , no follow-up action necessary . <br /> 4. <br /> 5 . <br /> 6 . <br /> 7 . <br /> 8. <br /> 9 . <br /> 10 . <br /> 11 . <br /> 12 . <br /> VI . OWNER / OPERATOR ACKNOWLEDGMENT OF COMPLIANCE ISSUES <br /> I have reviewed Section III " COMPLIANCE ISSUES " and provided a description in Section V of the action taken or to be taken <br /> to correct the issues discovered . <br /> Name of UST Owner/Operator ( Print) US O er/Op rator i Date Signed <br /> Masood Choudhuty 4/ 12/2021 <br /> CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council <br /> QA/QC APPROVED <br /> Rev IX 4/21 /20201 : 09 PMTara Neig <br />