COMPLIANCE INFO_2022 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK FACILITY EMPLOYEE TRAINING CERTIFICATE (Page 1 of 1) I. FACILITY INFORMATION Business Name (Same as Facility Name or DBA -Doing Business As) CERS ID VALLEY PACIFIC PETROLEUM SERVICES, INC. Business Site Address City ZIP Code 152 FRANK WEST CIRCLE SUITE 100 ISTOCKTON 195206 II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION Name of Designated UST Operator Providing the Training (Print as shown on the ICC Certification.) G. Michael Eliason Mailing Address Phone # 152 Frank West Circle, Stockton CA 1 (209 993-8793 ICC Certification # ICC Certification Expiration Dat; 5250416 III. FACILITY EMPLOYEE INFORMATION 5/30/2021 Individuals assuming the duties of the facility employee before October 13, 2018 must be trained within 30 days of performing facility employee duties. Individuals assuming the duties of the facility employee on and after October 13, 2018 must be trained before performing facility employee duties. 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 information in this section. Name of Individual(s) Trained Initial Training Date Date of Assuming Responsibility as a Facility Employee TOM SOMRATY 6/24/2013 6/24/2013 DAVE BRITTSON 3/17/2014 3/17/2014 VASCO SOARES 4/6/2015 4/6/2015 CAMRON CROUCH 11/3/2014 11/3/2014 JOSE BECCERA-ALVAREZ 6/12/2017 6/12/2017 MEHRAN KHAN 5/6/2019 5/6/2019 ANDRES GUILLEN 6/29/2020 6/29/2020 HENRY DULAY 6/18/2019 6/18/2019 IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING The facility employees listed above have completed the required training in accordance with California Code of Regulations, Title 23, Division 3, Chapter 16, Section 2715(c) and all the information provided herein is accurate. Trainjap Desinnated UST. nPAtrin-,r4ennat- 4/29/2021 CERS = Cafibrnia Environmental Reporting System, ID = Identification, ICC = Intematonal Code Coundl, UST = Underground Storage Tank