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1800 North California Street PR0231036 <br /> September 27, 2021 Program: UST <br /> PHOTO 1: Incomplete Facility Employee Training Certificate. Dates of initial trainin and assuming responsibility are inconsistent. <br /> UNDERGROUND STORAGE TANK r <br /> FACILITY EMPLOYEE TRAINING CERTIFICATEo I <br /> Business Name (Page 1 of 11 <br /> (Same a5 Facility Name orOBA-Doing Bus- SSF�ACILITy INFORMATION <br /> Business siteCE <br /> i RS ID e s D'ry ZIP coae <br /> IL DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Dme Designatetl UST Operator Provitling the Training(P oras shown yt <br /> ave Winkler on me rcc cenmeannrrl <br /> Mailing gtltlress r <br /> 416 2nd Street Galt CA 95632r <br /> ICC Cenirl.fi-# Phone# W <br /> 209 744-0112 <br /> 8883059-UC Icc ceniecanon Ezplration Date o <br /> 2/17/2022 M <br /> III. FACILITY EMPLOYEE INFORMATION In <br /> 1 <br /> facil,duals assuming the duties of the faciliTy employee before October 13,2016 must be trained within 30 da <br /> facility employee duties.Individuals assuming the duties of the facility employee on must <br /> after October 73,2016 musttrained <br /> before per(o days oftPerformingbet fied <br /> rming facility employee duties. <br /> Check this box ifs list of the individual(s)trained is appended ro this/orm.The <br /> al/of rhe information in this section. PPended list are minimum,must contain O <br /> Name of Individual(.)Trained Data of Assuming <br /> Initial Training Date Responsibility as a <br /> n� Ol�l Sd�J Facility Employee <br /> - <br /> Lk iewl /l Zu I/l�All, <br /> 11 1 k17- I 1 J-/z4 <br /> lrcDlzo ��« 1 r , <br /> 6a r /u <br /> t�ev tV) <br /> oU l 111)H-1-1 it/1 /2r _ <br /> J / Pel 24 <br /> s <br /> IV. CERTIFICATION 13Y DESIGNATED UST OPERATOR CONDUCTING THIZCode <br /> The facility employees listed above have completed the required training in accordance with Califulations, <br /> 71Ge 23,Division3,Chapter 16,Section 2716(c)and all the information provided herein is accurate. <br /> 0110 <br /> Training Designatetl UST Operator Signature DatL� <br /> CERS•CeWorde ErMmrarental Repa*V System,ID=ldentig.0 n,ICC=IntemaAo"al Code Cotstot UST=UndeigmLr)d&mW Tarlk <br /> Lydia Baker, SR. REHS Page 1 of 22 <br />