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13850 N De Vries, Lodi, CA 95240 <br />08/17/2021 <br />PHOTO 2: <br />Report provided to owner oaerator on 01/06/2021 <br />Underground Storage Tank <br />DE's Hated UST Operator Visual Inspection Report <br />FACILITY INFORTION <br />Inspection Date 01/06/21 <br />CERS ID 10181479 — <br />Name Mid Ciry Ca FO Regen <br />Facility city ZIP Code <br />95242 <br />Facility Address Lodi <br />13850 Devries Road OPERATOR INFORMATION <br />illsT <br />Operator Phone <br />Nam K nd esianated US <br />888-588-8737 <br />Kraig Certification Expiration Date <br />ICC Certification 11/18/22 <br />8296393 <br />3• COMPLIANCE ISSUES <br />li. <br />i <br />ormed in compliance with Californidaedotle <br />CERTIFICATION BY DESIGNATED UST OPER TOR CONDUCTING INSPECTIONv <br />4 inspection, pe <br />I hereby certify that the visual inspection r 16, section 2716 and all information pro <br />of Regulations, title 23, division 3, <br />herein is accurate. Date Inspection Report Provided to Owner <br />gerator Si�f 6 'ea by Ol /06/2] <br />Designated U�(a <br />Date:2Kinder <br />2021- <br />021.01.06 <br />Kinder _ 08 16 46-08'00' <br />System , ICC =International Code Council, nderground <br />CERS =California EnvironmentalRUDC eporting <br />Identification, NA =Not App cable <br />Under -Dispenser Containment, US = <br />Storage Tank Page 1 of 4 <br />PR0231547 <br />Program: UST <br />1�. <br />FR- <br />AL>m) <br />�. Fa,:_ <br />-APIA <br />E <br />VICKY VANG-LEE, EHS Page 2 of 5 <br />