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_;7—p . <br /> UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page i of 1) <br /> I. FACILITY INFORMATION <br /> Business Name(Seine as Facuity Name or DBA-Doing BirSlness As.) CERS ID <br /> West Valley Auto Service LLC i 10184725 <br /> Business Site Address city ZIP Code <br /> 2615 West Grantline Road Trac 95304 <br /> Ih DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training(Print as shown on the ICC Certification.) <br /> Rick Branchini <br /> Mailing Address Phone# —� <br /> 2947 Calypso Circle EI Dorado Hills CA 95752 _ (925) 699—1 396 Ext. <br /> ICC Certification# iCC Certlficationffioration Date <br /> 8164986 6/2/2022 <br /> Ill. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employee before October 13,2018 must be trained within 30 days of performing facility <br /> employee duties. individuals assuming the duties of the facility employee on and after October 18,2018 must be trained before performing <br /> faciilty employee duties. I <br /> ® Check this box if a list of the individual(s)trained is appended to this form. The appended list at a minimum must contain all of the <br /> information In this section. <br /> Initial Training Date Date of Assuming <br /> Name of Individuals}Trained Responsibility as a <br /> Facility Employee <br /> Also see appended list I <br /> Hakimi Wais 10/01/16 10101116 <br /> I Ramiro MW* 7115124 7115124 <br /> Sayeed Emran 7!41117 7141117 <br /> Melanie Enebarez* 7115120 7/15/20 <br /> Rocky Durani 11101/20 11/01120 <br /> l Cassie Lazar 12!01118 –- 12120118 <br /> ] I <br /> i <br /> f <br /> *See sumplmental forms attached for refresher training <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br /> The facility employees listed above have completed the required training in accordance with California Code of Regulations, <br /> l title 23,division 3, chapter 16,section 2715(c)and all the information provide herein is accurate. <br /> Training Designatdr e tar nature Date of Training <br /> I` le, 11/11121 <br /> CERS=California Environmental Reporting systems,ID=Identification,ICC=International Code Council,LIST=underground storage tank <br />