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190320-598 <br /> UNDERGROUND STORAGE TANK <br /> FDESIGNATED UNDERGROUND STORAGE TANK OPERATOR' VISUAL INSPECTION ' REPORT (Page 1 of 2) <br /> L FACILITY INFORMATION <br /> Date of Designated UST Operator Inspection <br /> 04/03/ 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 /> 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 /> 111 . 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 /> 66 <br /> 70 <br /> 84 <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 ogdnCy signed Ey Krag Kidw <br /> Kraig Kidder Datrzo19 W.o31241:M <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 Ill. <br /> 1 . Confuvied, no follow-up action necessary . <br /> 2 . Confinned, no follow-up action necessary . <br /> 3 . <br /> 4. <br /> 5 . <br /> — 7 — — <br /> 80 <br /> _ 9. <br /> 10 . <br /> 11 . <br /> 12 . <br /> VI . OWNER I 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 /> Date Signed <br /> Name of UST Owner/Operator (Print) US ' w ~ r/Oper for Sig to <br /> Masood Choudhary l 04- 12 -2021 <br /> CERS = California Environmental Reporing System, ID = Identification, UST = Underground Storage TankCC = International Code Cound <br /> , I <br /> I <br /> l <br />`r <br /> I <br /> I <br />