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C_ <br /> C) <br /> D O N <br /> 7 IN 0 <br /> N ` <br /> 0. <br /> _ Appendix XIII <br /> U) 8 Underground Storage Tank CDC/)Designated UST Operator Visual Inspection Report x o <br /> 1. FACILITY INFORMATION Z N <br /> CERS ID "amm I o1 $2 305 Inspection Date 06/28/2021 n <br /> w ¢ <br /> w CD <br /> Facility Name �. <br /> 7-Eleven 41341 <br /> aq <br /> Facility Address City ZIP Code o z <br /> -4445 Pacific Ave Stockton 5207 CD <br /> 2. DESIGNATED UST OPERATOR INFORMATIONo <br /> Name of Designated UST Operator Phone <br /> Ramon Rios (949)460-55200 Q <br /> ICC Certification Certification Expiration Date <br /> 9213646 6/3/2023 O CD <br /> 3. COMPLIANCE ISSUES civ <br /> 1.Observed liquid in UDC 1/2 <br /> O <br /> O � <br /> O <br /> CD <br /> CDC <br /> N <br /> CD ~ <br /> n N <br /> CD <br /> p O <br /> �s CD <br /> O � <br /> n <br /> CCD <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION CD c <br /> 1 hereby certify that the visual inspection was performed in compliance with California Code Cn CD <br /> 0 <br /> of Regulations, title 23, division 3, chapter 16, section 2716 and all information provided <br /> herein is accurate. CD <br /> o <br /> Designat UST Operator Signature <br /> Date Inspection Report Provided to Owner o. Cn <br /> 06/28/2021 C) <br /> 00 <br /> N N <br /> CERS = California Environmental Reporting System, ICC = International Code Council, ID = C <br /> 1 <br /> CD <br /> o Identification, NA = Not Applicable, UDC = <br /> Under-Dispenser Containment, UST = Undergroundo <br /> 1 Storage Tank <br />