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NOW <br /> Appendix XIII <br /> Storage Tank <br /> Underground ection Report <br /> p erator Visual insp <br /> Designated UST p <br /> TION Inspection Date � �Z <br /> 1, FA <br /> CILITY INFORMA <br /> CERS ID 19 City I ZIP Code <br /> —� �-- <br /> Facility Name II�^, <br /> Facility Addr est C -tc� d'"� <br /> 225: <br /> DESIGNATED UST OPERATOR INFORMATION Phone <br /> 2' operator (925) 290-9873 <br /> Name of DesigHated UST Op <br /> Certification Expiration Date --�� <br /> Terek Naward 2_4-24 <br /> ICC Certification " <br /> 8146896 <br /> 3. COMPLIANCE ISSUES <br /> L � - 817 -► �` <br /> C <br /> �o. z3 <br /> AO <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> I hereby certify that the visual inspection was performed <br /> 2716 and all information onnce with alifornia provided ode <br /> of Regulations, title 23, division 3, chapter 16, sec <br /> herein is accurate. <br /> d UST O er to Si toe Date Inspection Report Provided to Owner <br /> Designate ( j (� — L_?::, <br /> RS = California vironmental Reporting System, ICC = International Code Council, ID = <br /> CE Not Applicable, UDC = Under-Dispenser Containment, UST = Underground <br /> Identification, NA = <br /> Storage Tank <br /> P q f4 <br />