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190522- 128 <br /> UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND 'STORAGE TANK OPERATOR` VISUAL INSPECTION REPORT (Page 1 of 2) <br /> L FACILITY INFORMATION <br /> CERS ID Date of Designated UST Operator Inspection <br /> 10141507 1 06/26/ 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 /> ll . 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 Vll through X/ must be explained in this section and may require follow-up action . <br /> 1 . N/A Tank Tightness Testing- Secondarily Contained and a Suction System <br /> 2 , N/A Line Tightness Testing- Secondarily Contained and a 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 UgIATIsgmdby ' agKmde <br /> Kraig KinderOate' 2019 MM 07:25' '. <br /> -0M <br /> V. OWNER / OPERATOR DESCRIPTION OF FOLLOW- UP ACTIONS <br /> All issues listed in Section /1/ 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 IIL <br /> 1 . Confinued, uo follow-up action necessary . <br /> 2 . Confirmed , mo follow-up action necessal) <br /> 3 . ..... <br /> - 4 . <br /> 5 . <br /> 6 . <br /> 8 . -- -- — � <br /> 9 . ----- <br /> 11 . _ <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) USTIn Opera or Sig ur Date Signed <br /> Masood Choudlnuy 04- 12 -2021 <br /> CERS = Califomia Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = Intemational Code Council <br /> i <br />