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190410-654 <br /> UNDERGROUND STORAGE TANK <br /> FDESIGNATED UNDERGROUND STORAGE TANK OPERATOR VISUAL INSPECTION REPORT (Page 1 of 2) <br /> i . FACILITY INFORMATION <br /> S I D Date of Designated U ST Operator Inspection <br /> 10141507 05/02/ 19 <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 Certification . ) Phone # <br /> Kraig Kinder 1 (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 WX 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 nyixrvoyMenrwa342 <br /> Kraig Kinder �,kw2U1995 ,Di 1D,2 <br /> V. OWNER / OPERATOR DESCRIPTION OF FOLLOW- UP ACTIONS <br /> All issues listed in Section Ill above must have a description of the follow-up action taken orto 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 . Confirmed , no follow-up action necessary . <br /> 2 . Coufumed , uo f'ollowtip action necessary . <br /> 3 . <br /> 4. <br /> 5. <br /> 6. <br /> 7 . <br /> 8. <br /> 9 . <br /> 10. -- w— <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) USr/Ope ator Si air Date Signed <br /> Masood Choudlnmy 04 - 12 -2021 <br /> CERS = California Environmenta' Reporting System , ID = Identification, UST = Underground Storage Talk, ICC = International Code Council <br /> t <br /> t <br />