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Appendix XIII
<br /> Underground Storage Tank
<br /> Designated.UST Operator Visual Inspection Report
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<br /> CERS ID 10480:605 Inspection Date 6W21,
<br /> Facility Flame Flag City Chevron
<br /> Facility Address City ZIP Code
<br /> 6421 Capital Ave Lodi 95242
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<br /> Narne:of Designated UST Operator Phone
<br /> Alex Jabbari 926-'389-1262
<br /> ICC Certification Certification Expiration Date
<br /> 6243897-UC 9!2122
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<br /> f hereby certify that the visuat inspection-was perfonned in compirance with Catiforniia Code
<br /> of Regulations, title 23, division 3, chapter,16, section 2716 and all Information provided
<br /> herein is accurate.
<br /> Designated UST Ope�raator,Signaty_rq, Date Inspection Report Provided,to Owner
<br /> CERS = California Environmental Reporting System, IGC = International Code Council, ID
<br /> Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, UST = Underground
<br /> Storage Tank
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