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fforda-Te 416 2"4 Street Phone:(209)744.0112 <br /> Cult,Cu 95632 Fax: (209)744-0116 <br /> affordaRsofteem.not <br /> Owner Statements of Designated Underground Storage Tank Operator `� 1010 <br /> and Understanding of and Compliance with UST Requirements <br /> Facility Name: SRI] Facility#: 1486 <br /> Address: 749 CHAR'1'i✓RWAY Stockton, CA "f <br /> Facility Phone#:209-465-8979 XX ehsnpeof De4hjv,,trd Opre..r..r <br /> 0 Now Draipnutcd Operntor <br /> DF,SIGNATED UST OPERATOR FOR THIS FACILITY: <br /> PRIMARY <br /> I'kcignnlcd Opantor's Nnmw ZANB NIMMO Service Technician <br /> Rreinem Nome AFFORDA TEST ICC a: 4263.1224 IC <br /> Ocsignnted Opernlor'S phone: 209.7440112 fiNplmtion lmo: 3212 <br /> ALTERNATEI <br /> Dcsiltmdcd Opcmtw's Namo: FF.TAX RAMIREZ Scrvicu Tcchniciin <br /> Nognevr Nnmc: AFFORDA TEST ICC a: 52731934.1147 <br /> Desiµnntod 00eralor'E Phare; 209,744.0112 19xpirmion Date: 4/7/12 <br /> ALTERNATE2 <br /> Dosignotcd Oocrnlor's Namc: DAVID WINKLER Scrvicc Technician <br /> 9uxine N Nome' AFFORDA TEST ICCrh 5261373-UC <br /> rhsltinatcd Operator's Phone: 209.744.0112 L+xpimtion Date: 324A2 <br /> ALTCRNATE3 <br /> Ducip,natodOpanlor'sNumc: LYLENIMMO Sixvice'I'cohnicinn <br /> 1311sinom Nino: AFFORDA TEST ICC N: 524011 5-1 IC <br /> Dc:iaenled Opantor's Phony. 209-744.0112 Expiration Dow 2124/t2 <br /> I ecrtiry that. 1"or tho facility indiealed at the top of this page,the individuals listed above will serve t1.9 Designated UST <br /> Opvruiom The individuals will conduct and document monthly laullily inspections and annuid Ihcility,employee training,in <br /> Accordance with Calilomia Codc ol'Rcgulations,litic 23,suction 2713(e)—(D. <br /> Furthermore,I understand and um In wmpaanec with the requiremouts(statutes,regulations,and local <br /> Ordinances) opplieubio to underground storaac tankx- <br /> NAM E OF TANK OWNER(Print): Mohammed Ravwan (Johnny) <br /> SIGNATURE OF TANK OWNER: <br /> frxY <br /> DATE:August 13,2010 OWNERS PHO.N:E: �'9 L�b5' 297 9 . any• 3�l •25 7$ <br /> NU'I'Ii <br /> I) SUBMIT THIS COMpI.L•TI>D FORM TO'I'IIG IACAI.AGI?NCV(NOTSWRC[i)nl^rBR SIGNIN(;•'fliR I.UCAL AGtlNCY <br /> LIST IS AVAILABLE AT: www wutcrbaardS,c;I,EOX(Uyt(cgplpftBLfua <br /> 2) NU VIFY THE LOCAL AGENCY OF ANY CI•IANCGS TO THIS INFORMATION WITIIIN 30 DAYS OF Ti lli CHANG15. <br /> orrrCE: <br /> County: Date Faxed: Date Scanned: ... <br /> LA (I « 56D09ti602 >Uge 06.lej Sl )OM 6G:9L 8L-80-OLOF <br /> r,nn r7h trarc , %Fd SS:CT 60/60 OTOZ <br />