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181126- 526 <br /> UNDERGROUND STORAGE TANK <br /> FDESIGNATTED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Pagel of 2 ) <br /> I . ' FACILITY INFORMATION <br /> S ID Date of Designated UST Operator Inspection <br /> 10141507 12/ 14/ 18 <br /> Business Name (Same as Facility Name orDBA-Doing Business As) <br /> Manteca CO <br /> Business Site Address Citv ZIP Code <br /> 430 W . Center Street Manteca 95336 <br /> 11 . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator (Print as shown on the ICC CeHi(ication . ) 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 "NA " in sections VII through XI must be explained in this section and may require follow-up action. <br /> _ 1 • 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 /> 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 Kraig Kinder2016„g,xob, ",2 <br /> Oal<. . 12.14 12.-1507 <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 necessaty . <br /> 2 . Confirmed, no follow-up action necessary . <br /> 3. <br /> 4. <br /> 5. <br /> 6 . <br /> 7. <br /> 8. <br /> 9 . <br /> 10 . <br /> 12, <br /> VC 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) UST /Oper for S' ur Date Signed <br /> Masood Clioudhiuy 04 - 12 -2021 <br /> CE RS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = Iniernational Coda Council <br /> 4 <br />