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••. ni.rvlSl -- <br /> SENSOR ALHRII <br /> -G I <br /> I'J <br /> SEN Rr� <br /> DEC 6, <br /> F UEL N1 NRI1 9:45 f�'� <br /> DEC, b. 202 <br /> bink <br /> Design, nspection Report <br /> 3 <br /> 1. FACILITY INFORMATION <br /> CERS ID 10180877 Inspection Date 12/14/23 <br /> HFac—ility—Naame Western Food & Fuel <br /> Facility Address Gity ZIP Code ? <br /> 3032 Waterloo Rd Stockton 195205 <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone o <br /> Alex Jabbari 925-389-1262 <br /> ICC Certification Certification Expiration Date <br /> 5243897-UC 8/18/24 Co. <br /> 3. COMPLIANCE ISSUES > tO °' O <br /> N O <br /> Monitoring certification has been scheduledD <br /> 75 SB 989 test is over due a m CO 0 o <br /> N.'O W G O <br /> Co O c0 i <br /> N O (D <br /> ry N . <br /> CD n <br /> (o c <br /> D (D N 4 (D <br /> n (D < <br /> D O D (D <br /> N 2 <br /> m v ( <br /> N N <br /> N N .� <br /> C1 '' <br /> m <br /> O tD co U <br /> �O <br /> U1 � <br /> N N <br /> � N <br /> � O <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> I hereby certify that the visual inspection was performed in compliance with California Code N <br /> of Regulations, title 23, division 3, chapter 16, section 2716 and all information provided <br /> � f <br /> herein is accurate. o <br /> m <br /> Designated UST Operator Signature <br /> Date Inspection Report Provided to Owner <br /> 12/14/23 R <br /> "u <br /> CERS = California Environmental Reporting System, ICC = International Code Council, ID = <br /> Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, UST = Underground <br /> Storage Tank <br /> UN-111 <br /> www.unldocs.org <br /> Rev.10101120 page 1 Of 4 <br /> Rev. 10/01/20 f7 <br /> --- age 1 of 4 <br />