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N = CI) (D <br /> 0 0 ON <br /> o oo < <br /> N Appendix Xill Q �* N m <br /> o Underground Storage Tank Cn c <br /> Designated UST Operator Visual Inspection Report c <br /> M0v <br /> o <br /> = <br /> U) 1 FACILITY INFORMATION N � <br /> Inspection Date 0 <br /> CORS ID 10184725 8!19!2021 -0 <br /> Name west Valley Auto Service LLC <br /> CD 0 <br /> Facility m <br /> cility Address <br /> City ZIP Code o r- <br /> F6?5 yp Grant Line RD Tracy 95304 C7 <br /> (D <br /> Z pESlGNATEQ UST OPERATOR INFORMATION N <br /> 0 <br /> Name of designated UST Operator Phone �1 0 � <br /> Rick Branchini <br /> (925)699-1396 0° <br /> ICG Certification Certification Expiration Date � <br /> 8164986 61212022 0 <br /> N <br /> g, COMPLIANCE ISSUES N <br /> U) r <br /> C,VR TLS-350 (5, CD <br /> CD <br /> System in alarm at time of inspection L-4 = <br /> RepoA this period: L-4 High Liquid Alarm 8110,8/13 Alarm noted Elite 4 Service tech scheduled m ;l <br /> a Q <br /> for diagnosis and repair <br /> i'ISD Vapor leak warning 8111121 see notes on alarm log 0 v <br /> o <br /> 0 >D <br /> -0 (.0 <br /> t CD cn <br /> v w <br /> �Y O <br /> 0 <br /> 7 <br /> OD <br /> W <br /> CD <br /> N <br /> CD <br /> N <br /> N <br /> II <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 /> Digitally signed by Rick Branchini <br /> r ? Date:2021.06.19 14:59:50-07'00' 811912421 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, ID = <br /> identification, NA = Not Applicable, UDC = Under-Dispenser Containment, UST = Underground <br /> Storage Tank <br /> 0 <br /> 0 <br /> UN-111 www.unidocs.org Rev.10101120 page 1 Of 4 Q <br /> W <br /> p <br /> cn � <br /> m � <br /> 0 <br /> CD (n <br /> 0 <br /> 0, <br /> w <br /> � v <br />