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UNDERGROUND STORAGE TANK <br /> FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1) <br /> I._ FACILITY INFORMATION _ <br /> Busyness Name(Same as FaRifity Name or DBA-Doing Business As,) CERS ID <br /> West Valley Auto Service LLC 10184725 <br /> eustness Site Address City ZIP Code <br /> 2615 West Grantline Road Tracy 9530.4_ <br /> II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br /> Name of Designated UST Operator Providing the Training(Printas shown on the ICC Certification.) <br /> Rick Biranchini <br /> Mailing Address Phone# — <br /> 2947 Calypso Circle El Dorado Hills, CA 95762925 699 - 1396 Ext. <br /> ICC Certification# ICC Certification Expiration Date <br /> 8164986 6/2/2022 <br /> III. FACILITY EMPLOYEE INFORMATION <br /> Individuals assuming the duties of the faculty 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 13,2018 must be trained before performing <br /> facility employee duties. <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 Individual(s)Trained Responsibility as a <br /> Facility Employee <br /> Also see appended list <br /> Hakimi Wais* 1:0101/16 10/01116 <br /> Ramiro MW 7/15120 71151.20 <br /> Sayeed Emran * 7101117 7101117 <br /> Melanie Enebarez 7115120 7115120 <br /> Rocky Qurani * , 11/01120 11/01/20 <br /> Cassie Lazar 12/01/18 12/20/18 <br /> *See sump Imental 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 /> title 23,division 3,chapter 16,section 2715(c)and all the information provide herein is accurate. <br /> `training Designated LIST Operato S' natur �� Date of Training <br /> l 212fl122 <br /> CERS=California Environmental Reporting Systems,ID=Identification,ICC=International Code Council,UST=underground storage tank <br />