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I <br /> Designated U: wE$1ErW,d <br /> 363_ rz�tao • �r. 1 port <br /> FCERS <br /> FACILITY INFORMATION sToc <br /> �9. - ction Ree a- eas-a , ie ID Nov ;�o . <br /> 10180er� <br /> Facility Name ion Date <br /> Western Food & t S`;STEI-1 ST:+TU`s RhF'„I(t 11 /30/22 <br /> Facility Address p,LL FUNCTIONS NORIb"L <br /> 3032 Waterloo RdI ZI95205P Code <br /> 2. DESIGNATED UST OPERATC <br /> Name of Designated UST Operate <br /> Alex Jabbari 69-1262 <br /> ICC Certification <br /> 5243897-UC 1iISToRv REPORT cation Expiration Date <br /> 3 , COMPLIANCE ISSUES �. R <br /> No compliance Issues since my last <br /> Monitoring certification has been s� \ <br /> N ' <br /> UN�61 <br /> 4, CERTIFICATION By DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> hereby certify that the visual inspection was performed in compliance with California Code <br /> section 2716 and all information provided <br /> of Regulations , title 23 , division 3 , chapter 16, <br /> herein is accurate. Date Inspection Report Provided to Ownj <br /> Designated UST Operator Signature <br /> c <br /> Sys ICC = International Code Council, ID = <br /> CERS = California Environm�bleRUDorting SyC = Under-Dispenser Containment, UST = Underground <br /> Identification , NA = Not App <br /> Storage Tank www.unldxa.orp Rev. WGIM Page 1 <br /> UN-111 <br /> I MG_5117 <br />