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v <br /> Appendix Xlll <br /> Underground p Storage Tank <br /> Designated UST <br /> 1. FACILITY INFORMATION Perator Visual Inspection Re <br /> CERS ID Pitt <br /> 10181585 _ <br /> Facility Name WATERLOO LIQUORSInspection D,t <br /> 5118/2023 <br /> Facility Address 2512 EAST WATERLOO ROAD - <br /> City <br /> 2. DESIGNATED UST OPERATOR INFORMATION STOCK-TON ZIP Code <br /> Name of Designated UST Operator 95205 <br /> Edward Steams Phone <br /> ICC Certification 209-744-0112 <br /> I 8883080-UC Certification Expiration Date <br /> 3. COMPLIANCE ISSUES 3/312024 <br /> Identify by number all compliance issues listed <br /> r <br /> 4. CERTIFICATION BY DESIGNATED UST OPERATOR CONDUCTING INSPECTION <br /> I1 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 Owne <br /> GE*wd Q3&Wff 511812023 <br /> F. <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 <br />