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Appendix XIII <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspectionspection Repo <br /> 1. FACILITY INFORMATION rt <br /> CERS ID 10181585 <br /> Inspection Date 12_15-23 <br /> Facility Name Waterloo Liquor's <br /> / <br /> Facility Address Waterloory <br /> Road city Stockton ZIP Code <br /> 95219 <br />,ed 2. DESIGNATED UST OPERATOR INFORMATION <br /> 023 Name of Designated UST Operator Phone <br /> Ashley Nimmo <br /> 209-744-0112 <br />'23 <br /> G1hICC Certification <br /> 10317263-UC p Certification Expiration Date <br /> 6/27/25 <br /> i <br /> 3. COMPLIANCE ISSUES <br /> Identify by number all compliance issues listed <br /> ifeia <br /> tt5 <br /> I <br /> it <br /> I <br /> 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 /> Designated UST Operator Signature Date Inspection Report Provided to Owner <br /> Ash 12-15-23 <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 /> Page 1 c <br />