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P <br /> Appendix XIII <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> ,L 1. FACILITY INFORMATION <br /> fit! CERS ID10181239 Inspection Date 6-30-23 0 <br /> Facility Name A & A Gas & Food <br /> Facility Address City ZIP Code <br /> 16 E Harding Way Stockton 95204 <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Name of Designated UST Operator Phone <br /> Ashley Nimmo 209-744-0112 <br /> ICC Certification Certification Expiration Date r <br /> 10317263-UC 6/27/25 <br /> i <br /> 3. COMPLIANCE ISSUES <br /> Identify by number all compliance issues listed <br /> I . <br />,1 N <br /> ` < N <br /> 0 <br /> a <br /> a <br /> 5 <br /> T <br /> i <br /> n � f <br /> I' 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 /> ti---------------------- <br /> Designated UST Operator Si nature Date Inspection Report Provided to Owner <br /> 06-30-23 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, ID = f <br /> Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, UST = Underground <br /> Storage Tank <br /> Page 1 of 4 <br />