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1990 N Piccoli Rd, Stockton, CA PR0231820 <br /> 11/08/2021 Program: UST <br /> PHOTO 1: <br /> Chadwick Cozzort has not been reported in CERS on the desi nated o erator identification form. <br /> rUndergounld Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 7. FACILrry INFORMATION ------------— - <br /> CERS ID <br /> Facility Name S� Inspection Date F <br /> Facili z <br /> ty Address I I ZIP Code <br /> 1 O &COO G City ?� <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name Of Designated UST Operator <br /> Phone s-4Cr9 <br /> ICC Certification 7 s -3.9' <br /> S Certification Expiration Date <br /> 3. COMPLIANCE ISSUES/ —131"-s <br /> I <br /> i <br /> i <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> I hereby certify that the visual inspection was performed in compliance with California Code <br /> of Regulations,title 23,division 3,chapter 16,section 2716 and all information provided <br /> herein is accurate. <br /> Designated UST Operator Signature Date Inspection Report Provided to Owner <br /> 7a <br /> S=CaNfomia Environmental Reporting System,ICC=International Code Council,ID= <br /> VICation,NA=Not Applicable,UDC=Under-Dispenser Containment,UST=Underground <br /> Tank <br /> Page 1 of 4 <br /> VICKY VANG-LEE, EHS Page 1 of 2 <br />