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NOW <br /> Appendix XIII <br /> Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 1. FACILITY INFORMATION <br /> CERSID 10181585 <br /> Facility Name Inspection Date_ <br /> WATERLOO LIQUORS 03-22-2023 <br /> Facility Address <br /> 2512 EAST WATERLOO RD City <br /> 2. DESIGNATED UST OPERATOR INFORMATION STOCKTON ZIP Code I <br /> 95219 <br /> Name of Designated UST Operator <br /> Felix Ramirez Phone — <br /> ICC CertificationWaterloo Li-quo's - <br /> 209-744-0112 Waterloo LlL'q-1 ors <br /> 8883072-UC Certification Ex Stocktoterloo <br /> Road <br /> 3. COMPLIANCE ISSUES 02-15-2024 209--3-q 114 95215 <br /> ,A <br /> Identify by number all compliance issues listed 93/�212023 09.17 <br /> TESTING DONE 03-07-2023 RP9$satoed TeTa Report <br /> sts) <br /> From: 03,01,2023 <br /> To : 03,22/2023 � <br /> Flow: 9ph <br /> 2 WIRE :-1:SOR (tN7NTHLV) � <br /> Name "• <br /> UNL SUMP <br /> End Date <br /> 93/21/2023 12:00:00 <br /> ii <br /> Name <br /> DIESEL SUMP <br /> End Date <br /> 03'21,2023 12:00:00 <br /> Name <br /> PREM SUMP 1 <br /> End Date J <br /> 03,21,2023 12:00:00 <br /> Name <br /> I DISP 1 AND 2 <br /> End Date <br /> 03{21,2023 12:00:00 <br /> Name <br /> DISP 3 AND q <br /> End Date <br /> 03/21,2023 12:00110 <br /> i <br /> Name <br /> UNL ANNULAR <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING 1 0;/21/;0,3 12:10-.10 <br /> I hereby certify that the visual inspection was performed in complianc( Name <br /> of Regulations, title 23, division 3, chapter 16, section 2716 and all info DIESEL ANNULAR <br /> End Date <br /> herein is accurate. 03'21%2123 12:00:00 <br /> Desiqnated UST Operator Signature Date Inspection RE No Records Found <br /> ' -' 03-23-2023 <br /> -- ICERS = California Environmental Reporting System, ICC = International Co <br /> identification, NA = Not Applicable, UDC = Under-Dispenser Containment, US► - <br /> Storage Tank <br /> Page 1 of 1 <br />