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190124 -555 <br /> UNDERGROUND,STORAGETANK <br /> F <br /> ED UNDERGROUND 'STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Pagel of 2) <br /> I . FACILITY INFORMATION <br /> Date of Designated UST Operator Inspection <br /> 02/05! 19 <br /> Business Name (Same as Facility Name orDBA - Doing Business As) <br /> Manteca CO <br /> Business Site Address City 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 Certification .) Phone # <br /> Kraig binder 1 ( 888 ) 588- 8737 <br /> ICC Certification # ICC Certification Expiration Date <br /> 8296393 12/07/20 <br /> 111 . COMPLIANCE ISSUES <br /> All answers of "N" or "NA " in sections Vll through XI must be explained in this section and may require follow-up action. <br /> 1 N/A Tank Tightness Testin – Secondaril l contained and Suction SLstem - <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 /> 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 Og3ary vgneeb Nag NNEe <br /> Kraig Kinder "b"190205 t �@69 <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 M. <br /> l_. __ Confrmed, no follow_-up action necessary . _— _ <br /> 2 . Confirmed, no follow-up action necessary . — <br /> 3 . <br /> 4. <br /> 5. <br /> 6. <br /> 7 . <br /> 8. _. <br /> 9 . <br /> lob <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 ' .dopenator Si a r Date Signed <br /> Masood Choudluuy `1` 04- 12 -2021 <br /> CERS = California Environmental Reporting Syslem, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council <br />