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� �f�1� 1\ /E® <br /> p4162 <br /> - _—tel 11,,.a.®� ®,��e v_ � <br /> orda-Te 416 2""Street Phone!(209)744-0112 <br /> Galt,Ca 95632 Fax: (209)744-0116 APR 07 201 <br /> aHorda softcom.net <br /> Owner Statements of Designated Underground Storage Tank Operator <br /> and Understandingof and Compliance with UST Re uirenilWYIRONMENTAL HEALTH <br /> Facility Name: St Joseph's Medical Center Facility#: DEPAKMENT <br /> Address: 1800 N California Street Stockton CA Updated Owners statement <br /> Facility Phone#: 209.461-5193 ❑Change of Designated Operator <br /> [I New Designated Operator <br /> DESIGNATED UST OPERATOR FOR]ULS FACU TTY: <br /> PRIMARY <br /> Designated Operatoes-Name:. ZANE NIMMO Service Technician <br /> Business Name: AFFORDA TEST ICC#: 5263322-UC <br /> Designated Operator's Phone: 109-744-0112 Expiration Date: 3/3/16 <br /> ALTERNATE <br /> Designated Operator's Name: FELIX RAMIREZ Service Technician <br /> Business Name: AFFORDA TEST ICC#: 52733934-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3/3/16 <br /> ALTERNATE2 <br /> Designated Operator's Name: DAVID WINKLER Service Technician <br /> Business Name: AFFORDA TEST ICC#: 5263373-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3/10/16 <br /> ALTERNATE 3 <br /> Designated Operator's Name! EDWARD STEARNS Service Technician <br /> Business Name: AFFORDA TEST ICC 0: 5250492-UC <br /> Designated Operator's Phone. 209-744-0112 Expiration Date: 3/3/ <br /> 1 certify that,for the facility indicated at the top of this page,the Individuals listed above will serve as Designated UST <br /> Operators. The Individuals will conduct and document monthly facility inspections and annual facility employee <br /> training,in <br /> Awordance with California Code of Regulations,title 23,section 2715(c)—(f). <br /> Furthee mm,i OW"itaed and am in with iha requltemaeta(atepdta,mookac and local <br /> Onliaaaeea) applicable to nnbe>pgaad sinew t ob& <br /> i'(Ai11i6 OB TANK OWNEA/Operwar(I nkat) Ae 117 <br /> X ? . <br /> BIpNATUk6 OF TANK Jnr <br /> DATE: - 'i 5� . _ OWNERS PHONE: <br /> Rats, <br /> 1) TOTEM LOCAL AGOMY Dc0'f awatCa)Atrm XONR .Taa 1ACAL <br /> AGErX'Y UST IS AVAILABLE AT: f <br /> 2) WrVY T99 LOCAL MMNCY O ANY CHATt(Sr2 T071M SURMATION WIT ON 3e DAY90e TIM <br /> CBAIWL <br /> Oflr/C'F: <br /> Ctwtaty: SCt Date Faxed: `_ Date Scanee4: <br /> DaOe F,-IHaind <br />