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May 04 11 02:55p Reliable Petroleur�A 209-845-8953 p.9 <br /> Owner tatements of Designated Underground Storage Tank (UST) Operator <br /> a id Understanding of and Compliance with UST Requirements <br /> Facility Name:C arter Way Chevron FacilityID#: <br /> Facility Address: 508W.Charter Way,Stockton CA 95206 Reason for Submitting this Form(Check One) . <br /> Change of Designated Operator <br /> Facility Phone#: 209465,3440 X Update Certificate Expiration Date <br /> Designated LST Onerator(s) for this Facility <br /> PRIMARY <br /> Designated Open or's Name: Robert Barnhart Relation to UST Facility(Check One) <br /> Business Name( different from above).Reliable Petroleum Services Inc. C Owner ❑ Operator ❑ Employee <br /> Designated Oper or's Phone#: 209-604-9336 X Service Technician ❑ Third-Party <br /> International Cod Council Certification#: 5252540-UC Expiration Date: 12-23-2011 <br /> ALTERNATE 1 lona! <br /> Designated Open or's Namc:Guadalupe Sanchez Relation to UST Facility(Check Ore) <br /> Business Name( different from above):Reliable Petroleum Services Inc. ❑ Owner ❑ Operator ❑ Employee <br /> Designated Open or's Phone#:209-604-9363 X Service Technician ❑ Third-Party <br /> Intemazional Cod Council Certification C 5250451-UC Expiration Date:01-29-2013 <br /> ALTERNATE 2 (Optional) <br /> Designated Ope or's Name: Relation to UST Facility(Check One) <br /> Business Name( different from above): ❑ Owner ❑ Operator ❑ Employee <br /> Designated Oper, or'sPhone#: ❑ Service Technician ❑ Third-Parry <br /> Intcmational Co Council Certification#: Expiration Date: <br /> 1q <br /> I 1certffy thal for the facility indicated at the top of this page, the individual(s) listed above Will <br /> serve as De gnated UST Operator(s). The individual(s)will conduct and document monthly <br /> facility insp ctions and annual facility employee training,in accordance with California Code of <br /> Regulations. title 23, section 2715(c)-(f), <br /> Furthermoi e,I understand and am in compliance with the requirements(statutes, <br /> regulations, and local ordinances) applicable to underground storage tanks. <br /> NAME OF TANK OWNER(Please Print): V E)--J W 2 $ti q yv r <br /> SIGNATURE OF TANK OWNER: <br /> DATE: D+ lI OWNER'S�PHONE#: <br /> November 20q <br />