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gg v <br /> Undergrround Storal e <br /> Designated Appendix UST Opera9 Tank I <br /> tor Visual Inspe <br /> I. F,4 FY INFORMATION Report <br /> CERS ID 10181585 <br /> Facility Name <br /> WATERLOO LIQUORS 04120,23 { <br /> Facility Address <br /> 2512 EAST WATERLOORD City = I <br /> — <br /> 2. DESIGNATED UST OPERATOR INFORMATION STOCKTON I,952o5de <br /> Name of Designated UST Operator <br /> ` <br /> David Winkler Phone —–� <br /> ICC Certification 209-744-0112 <br /> 3. COMPI Certification Expiration Date <br /> 3. COMPLIANCE ISSUES 2/1712024 <br /> identify by number aii compliance issues listed — <br /> i <br /> I <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> hereby certify that thevisual 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. 4. <br /> Desnated_UST Operator Signature ___ Date Inspection Report Provided to Owner <br /> _ 04120123 <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 1of4 <br />