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Dec 23 04 09: 30a Franzen Hill 55Q6881467 p. 1 <br /> v %W <br /> From: unknown Page:3/5 Date: 12/23120048:12:09 AM <br /> Dec 22 04 03:59p Franzen Hill 5599981467 p,3 <br /> San Joaquin County <br /> Environmental Health Department <br /> 304 E.Weber Ave„Third Floor Stockton CA 9$202 <br /> Telephone(209)468-3420 Fax(209)468-3433 <br /> I <br /> Owner Statements of Designated Underground Storage Tank(UST) Operator <br /> and Understanding of and Compliance with UST Requiroolonts <br /> Paetlity Nome; Ran Che $an MI uel Lodi TifirYMNo ' N—$016 <br /> ". PuCherokeean for Submitting dus Form(GYeet Ont) <br /> odi, CA <br /> FaeaityPbeae#:(209) 339-8200 Cbenge arDangnated OPwnprUpdate Cc+riFicete Expineian Dere <br /> j Designated UST Onerator(s)for this Facilitv <br /> PaIMARY <br /> Drsignatcd Opemtoe&Nam¢ Franzen—Hill Advtlonto UST Facfiay(Chock One) <br /> autiMn Name(!f00"emjrom above): <br /> ❑ owaar O OPantm O Emp <br /> Deignamd Opetuez'a Plr®e d: 559-688-2 977 tone <br /> lei ge+vice?ahaician Pf Thvd-Peet' <br /> InremaLorul Code Cooneil CntGfieation k: 524572q-UG A[Dimnea Dot¢ 11-19-06 <br /> j ALTERNATEI em <br /> Daismmed 0pemtnr's Nair Relation m USTFpei11 <br /> ry CCheckOnel <br /> liurineas Nano(Jjdigerr'tyrom above); D DwVer D Op=w 0 Empl <br /> Daigmred OpernbYr Phove#. oYea <br /> O Indo o ehdaiea D 7irird•Pay <br /> IDrematioaal Cade Caunen Cc[sifieafimn' Aplruion Date: <br /> ALTERNATES (OpNox , <br /> De<ignvled Opermor's Name: .Relation mt15TFacility(Cha0O .) <br /> Buvowr Name(7jdllfkrt a from nbov<). <br /> Deaig . <br /> D Dwnm D OPenror D Employtt �. <br /> aemd OPvaro+'a P1r�eA: O Service TeeEniann D Talyd-Forty <br /> humvuoml Code cxma dCatlFwioo M: <br /> �Pi*ariag Dara: <br /> NOTE:THE LOCAL REGULATORY AGENCY MUST BE NOTIFIED OF ANY CHANCES TO THIS <br /> INFORMATION WITHIN,30 DAYS OF THE CHANGE, <br /> F <br /> that, for the facility indicated at the top of this page,the individuals)listed above will <br /> i Designated UST Operdtor(s). The individuals)will Conduct and documentmonthly <br /> nspoctious and annual facility employee training,in accordance with CaliforniaCode of <br /> ioru,title 23,section 2715(c)-more,I understand and am in compliance with the requirements(statutes, <br /> ons,and local ordinances)applicable to underground Stora a tsF TANK OWNER Otase Print);_RE OF TANK OWNER: p�_-L���-oY �'sPHONEIl •.LmT /cw <br /> This fax was received by GFI FAXmaker fax server. For more information,visit:http:l/www.gfi.com <br />