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UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Pagel of 1) <br /> 1. FACILITY INFORMATION <br /> Business Name{Same as Facility Narne or DBA Doing Business As.JI CERS 10 <br /> West Valley Auto Service LLC 1 10184725 <br /> Business Site Address City , ZIP Code <br /> 2615 West Grantline Road Trac 95304 , <br /> 11. 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 /> Malling Address Phone# <br /> 2947 Calypso Circle EI Dorado Hills, CA 95762 925 Egg _ 1396 Ext. <br /> ICC Certification# ICC Certification Expiration Cate <br /> 8164985 6/2/2422 <br /> 111. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the facility employee before October 13,2448 must be trained within 30 days of performing facility <br /> employee duties. Individuals assuming the duties of the facility employee on and after October 43,2018 must be trained before performing <br /> facility employee duties. <br /> ® Check this box if a fist 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 /> i Initial Training Date Date of Assuming <br /> Name of Individual(s)Trained Responsibility as a <br /> Facility Employee <br /> Also see appended list <br /> Hakimi Wais 10101116 10101115 <br /> Ramiro MVII _ - 7115120 — 17/15/20 <br /> Sayeed Emran * 7101117 17/411/7 <br /> Melanie Enebarez 7115120 7/15/20 <br /> Rocky Durani 11101120 11/01120 <br /> Cassie Lazar* 12101/18 12/20/18 <br /> i <br /> *See sumplmerltal forms attached for refresher training <br /> IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAIM ING <br /> The facility employees listed above have completed the required training in accordance with California Code of Regulations, <br /> title 23,division 3, chapter 16,section 271 5(c)and all the information provide Herein is accurate, <br /> Training Designated U T Oiler ignat Date of Training <br /> Gam. -.._._ 21'f 0122 <br /> CERS=Califomia Environmental Reporting systems,Id=rdentification,ICC=International Code Council,UST=Underground storage tank <br />