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190617 - 698 <br /> UNDERGROUND STORAGE TANK <br /> FDRS <br /> ESIGNATED UNDERGROUND 'STORAGE TANK OPERATOR VISUAL "INSPECTION ' REPORT (Page 1 of 2 ) <br /> I . ` FACILITY INFORMATION <br /> ID Date of Designated UST Operator Inspection <br /> 10141507 07/23/ 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 /> II . 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 /> ill . COMPLIANCE ISSUES <br /> All answers of "M' or 'NA " in sections V11through XI must be explained in this section and may require follow- up action . <br /> 1 , N/A Line Tightness Testing- Secondarily Contained and is a Suction System <br /> 2 . N/A Tank Tightness Testing. Secondarily Contained and is a Suction System <br /> 3 , H - I Annular space sensor out alarm, atinesh Chandra resoponded to alarms I checked sensor for proper position and it is dry <br /> 4 . H -2 Fill sump sensor out alarm, Atinesh Chandra responded to the alarm alarms I checked sensor f-orproper position and it is dry <br /> 5 . H -5 Fuel Polisher sensor out alarm Atinesh Chandra responded to the alarm alarms I checked sensor for proper position and it is dry <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 Date 2 07. 6133614 <br /> Kraig Kinder -0?w 907 �6 » � <br /> V. OWNER 1 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 111. <br /> 1 . Conf tined, no follow-up action necessary . <br /> 2 . Confinned, no follow-up action necessary . <br /> 3. ConfuYned , no follow- up action necessary . <br /> 4. Confuined, no follow-up action necessary . <br /> 5. Confirmed, no follow-up action necessary . <br /> 6 . <br /> 7. - - - . - ----- -- - - - --..- - _ — -- - <br /> 9 . <br /> 10 . <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) US Oyefrer/O eratohsignore Date Signed <br /> MasoodClioudlnuy In/ ,v\ �„C_ 04 - 12 -2021 <br /> M/ <br /> E CERS = California EnvironmenW Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = Intemational Code Council <br /> QA/QC APPROVED <br /> 7/26 /20193 : 24 PMMegan Rodr <br />