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Appendix XII <br />Underground Storage Tank <br />Facility Employee Training Certificate (Page 1 of 1) <br /> <br />I. FACILITY INFORMATION <br />Business Name (Same as Facility Name or DBA -Doing Business As) <br />Manteca CO <br />CERS ID <br />10141507 <br /> <br /> <br />II. DESIGNATED UNDERGROUND STORAGE TANK OPERATOR INFORMATION <br />Name of Designated UST Operator Providing Training (Print as shown on the ICC Certification) <br />Kraig Kinder <br />Mailing Address <br />4780 Cheyenne Way, Chino, CA 91710 Phone # <br />(888) 588-8737 <br />ICC Certification # <br />8296393 <br />ICC Certification Expiration Date <br />11/18/2022 <br />III. FACILITY EMPLOYEE INFORMATION <br />Individuals assuming the duties of the facility employee before October 13, 2018 must be trained <br />within 30 days of performing facility employee duties. Individuals assuming the duties of the facility <br />employee on and after October 13, 2018 must be trained before performing facility employee duties. <br />□ <br /> Check this box if a list of the individual(s) trained is appended to this form. The appended list at <br />a minimum must contain all of the information in this section. <br /> <br />Name of Individual(s) Trained <br /> <br />Initial Training Date <br />Date of Assuming <br />Responsibility as a Facility <br />Employee <br />Ciril Uganiza 2022-09-06 2005-03-01 <br />Eric Rodriguez 2022-09-06 2018-12-17 <br />Christopher Miller 2022-09-06 2022-06-10 <br />Aninesh Chandra 2022-09-06 2014-12-15 <br />Michael Payne 2022-09-06 1999-04-01 <br />Tom Sigfried 2022-09-06 2001-03-01 <br /> <br /> <br /> <br /> <br />IV. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING THIS TRAINING <br />The facility employees listed above have completed the required training in accordance with <br />California Code of Regulations, Title 23, Division 3, Chapter 16, Section 2715(c) and all the <br />information provide herein is accurate. <br />Training Designated UST Operator Signature <br /> <br />Date of Training <br />2022-09-06 <br /> <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council, UST = Underground storage tank <br />Business Site Address City ZIP Code <br />Manteca 430 W. Center Street 95336