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190215 - 566 <br /> UNDERGROUND STORAGE TANK <br /> FDES7IGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (page 1 of 2) <br /> L FACILITY INFORMATION <br /> S ID Date of Designated UST Operator Inspection <br /> 10141507 03/05/ 19 <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 /> 11 . 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 "NA " in sections V11 through Xl most be explained in this section and may require follow-up action. <br /> 1 • N/A Tank Tightness TestingSecondarily 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 /> 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 <br /> Kraig Kinder Date: 2019 145e17 <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 onto 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 /I/, <br /> 1 • Confirmed, no follow-un 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 /> - 10 . _ _ — - — - - — <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) UST left perat�r Sign � r Date Signed <br /> Masood Clroudhury g _ 04 - 12 -2021 <br /> CERS = California Environments Reporting System, ID = Identification, UST = Underground StorageTank, ICC = International Code Council <br /> I <br />