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Address Delta Arco, 440 Martin Luther King Dr., Stockton CA, 95206 Record ID PR0231055 <br /> Date 8/24/2022 Program: UST <br /> PHOTO 2: <br /> Designated operator report done 1/28/2022 at 31 days. <br /> Appendix XIII Tank <br /> Underground storageaction Report - <br /> Designated UST Operator Visual Insp <br /> 1. FACILITY INFORMATION Inspection Date 0912822 <br /> CERS ID 10180903 <br /> ZIP Code <br /> Facility Name DELTA ARCO Y City STOCKTON 95208 <br /> Faci1,ityAddress440 W CHARTER WA <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Phone <br /> Name of Designated UST Operator 209444-01V <br /> David Winkler — Certification Expiration Date <br /> ICC Certification 2/17/2022 <br /> 8883059-UC -- ` <br /> 3. COMPLIANCE ISSUES <br /> Identity by number all compliance issues listed <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 <br /> J Date Inspection Report Provided to Owner <br /> 01/28%22 <br /> CERS=California Environmental Reporting System,ICC=International Code <br /> ideStontification, <br /> Tank NA=Not Applicable,UDC=Under-Dispenser Containment,UST=Council,Underground <br /> Gabriela Garcia-Mejia, EHS Page 2 of 3 <br />