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180924-503 <br /> UNDERGROUND STORAGE TANK <br /> FDE7SIGNATEDO UNDERGROUND STORAGE TANK PERATOR VISUAL INSPECTION REPORT (Page 1 of 2) <br /> L FACILITY INFORMATION <br /> S ID Date of Designated UST Operator Inspection <br /> 10141507 10/ 16/ 18 <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 /> IL 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 12/06/ 18 <br /> 111 . COMPLIANCE ISSUES <br /> All answers of "W or `NA " in sections Vl/ through XI must be explained in this section and mayrequire follow- up action . <br /> I . N/A Tank Tightness Testing — Secondarily contained and Suction System <br /> 2 . N/A Line Tightness Testing — Secondarily contained and Suction System <br /> 3 . <br /> 4 . <br /> 5 . <br /> 6 . <br /> _7 . <br /> 8. <br /> 9 . <br /> 10 . <br /> 11 . <br /> 12 . <br /> 1Va, 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 Dqukya9eA Dy Wxg bae <br /> Kraig Kinderq,m 18 10171142 29 <br /> V. OWNER / OPERATORDESCRIPTION OF FOLLOW- UP ACTIONS <br /> All issues listed in Section ill 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 lll. <br /> 1 Confirmed, no follow-up _action_necessar} . _ <br /> 2 . Confirmed, no follow-up action necessary . <br /> 3 . <br /> 4. <br /> 5. <br /> 66 <br /> 7. <br /> 8 . <br /> 9 . <br /> 10 . <br /> 12 . <br /> VL 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 ) U ... 10 ler/Opgrator n u Date Signed <br /> Masood Chondhury 1 04- 12-2021 <br /> ' V <br /> CERS = Califorra Environmental Reporting System, ID = Identification, UST = Underground Storage Tank ICC = Intemational Code Council <br /> I <br />