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1800 North California Street PR0231036 <br /> September 27, 2021 Program: UST <br /> PHOTO 2: Facilit Em to ee Trainin Certificate with different initial trainin and assuming responsibility dates. <br /> UNDERGROUNDSTORAGETANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE(Page 1 of 1) <br /> e Name(Same as Facility Name or DBA-oornl FACILITY INFORMATION I o <br /> T. JOESEPH'S HOSPITAL HBe°a�Aal <br /> Business Site Atldrese CERS ID <br /> 1909 CEMETARY LANE 10181391 <br /> City <br /> it• ZIP Cade DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Zai 95204 <br /> ne Nimmo <br /> Name of Designated UST Operator Providing the Training(Print as shown on me/CC Certification.) <br /> Mailing Address I <br /> 416 2nd Street Galt CA 95632 Phone# <br /> Icc ceniaoaaon# 209 744-0112 <br /> 8883064-UC ICC Cenifiwdon Expiration Date c <br /> 2/17/2022 n <br /> IIL FACILITY EMPLOYEE INFORMATION <br /> Intlividuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing <br /> facility employee duties.Individuals assuming the duties of the facility employee on and after October 13,2013 must be trained y <br /> Check this box if a list of the indiv/dual(s)trained is appended to this form.The a <br /> X <br /> all of the information in this secdon. ppendetllist,at a minimum,must contain Cn <br /> Name of Ind'Ividual(S)Trainetl Date of Assuming <br /> Initial Training Date Responsibility as a <br /> ALFREDO DOMINGUEZ Facility Employee <br /> 10/9/2019 10/9/2019 <br /> JOE KUHARIK 10/9/2019 10/9/2019 <br /> :HARLES CHAPPLE <br /> 10/9/2019 10/912019 � <br /> ANTHONY BARAJAS 10/9/2019 10/9/2019 y <br /> BRYON COPE 10/9/2019 1019/2019 <br /> JOE VIERRA 10/9/2019 10/9/2019 <br /> JUSTIN CUMMINGS 10/9/2019 10/9/2019 <br /> DEVIN PEARSON 10/9/2019 10/9/2019 <br /> DAREN KIGHTLINGER 10/9/2019 1019/2019 <br /> BRANDON DANIELS 10/26/2020 10/26/2020 8 <br /> g <br /> EE <br /> = i <br /> _1 <br /> � I <br /> N. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> {e facility employees listed above have completed the required training in accordance with California Code of Regulations, <br /> Title 23,Division 3,Chapter 16,Section 2715(c)and all the information provided herein is accurate. <br /> Training Designated UST Operator Signature Date of Training <br /> 1012612020 <br /> ID=Identification,ICC=International Code Counal,UST=Underground Storage Tank <br /> CERS•Catilomia Environrrrental Reporting System, <br /> Lydia Baker, SR. REHS Page 2 of 22 <br />