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2815790864 RYDER SYSTEMS 01:08:02 p,m. 10-26-2012 2/2 UNDERGROUND STORAGE TANK SYSTEM OWNER STATEMENTS OF DESIGNATED UST OPERATOR AND UNDERSTANDING OF AND COMPLIANCE WITH UST REQUIREMENTS For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23, Div. 3, Ch. 16 California Code of Regulations(CCR) FACILITY NAME FACILITY PHONE Ryder Truck Rental #1071 (209) 943-3213 FACILITY SITE ADDRESS CITY 3633 Duck Creek Drive Stockton REASON FOR SUBMITTING THIS FORM(Check One): LJ Change of Designated Operator N Update of ICC Certification Expiration Date(s) PRIMARY DESIGNATED UST OPERATOR FOR THIS FACILITY DESIGNATED OPERATOR NAME: Elmer Mortera RELATION TO UST FACILITY(Check One) BUSINESS NAME(If diiferenrfrom above): Balch Petroleum ❑ Owner ❑ Operator ❑ Employee DESIGNATED OPERATOR PHONE: (408) 942-5686 ext. ❑ Service Technician ® Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: 5248052-UC EXPIRATION DATE: 5/3/2013 ALTERNATE I DESIGNATED UST OPERATOR FOR THIS FACILITY(Optional) DESIGNATED OPERATOR NAME: Ryan Llpert RELATION TO UST FACILITY(Check One) BUSINESS NAME(If digerenifromabove): Baled Petroleum ❑ Owner ❑ Operator ❑ Employee DESIGNATED OPERATOR PHONE: (408) 942-8686 ext. ❑ Service Technician ® Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: 5295268-UC EXPIRATION DATE: 1017/2014 ALTERNATE 2 DESIGNATED UST OPERATOR FOR TIDS FACILITY(Optiowl) DESIGNATED OPERATOR NAME: Rolando Urbina RELATION TO UST FACILITY(Check One) BUSINESS NAME(1yUfferentfrom above): BalCtl Petroleum ❑ Owner ❑ Operator ❑ Employee DESIGNATED OPERATOR PHONE: (408) 942-8686 ext, ❑ Service Technician ® Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: 8009631-UC EXPIRATION DATE: 10/24/2014 ALTERNATE 3 DESIGNATED UST OPERATOR FOR THIS FACILITY(Optiowl) DESIGNATED OPERATOR NAME: RELATION TO UST FACILITY(Check One) BUSINESS NAME(ydiiferentfrom above): ❑ Owner ❑ Operator ❑ Employee DESIGNATED OPERATOR PHONE: ( ) ext ❑ Service Technician ❑ Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: EXPIRATION DATE: I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training in accordance with California Code of Regulations, Title 23, Section 2715(c) through (f). Furthermore, I understand and am In compliance with the requirements (statutes,regulations,and local ordinances) applicable to underground storage tanks. TANK OWNER NAME: Amy White (281) 647-8900 TANK OWNER TITLE: Wior Compliance Manager OWNER PHONE: x208 TANK OWNER SIGNAT DATE: October 25, 2012 INSTRUCTIONS L Report the name(s)of the Designated UST Operator(s) as registered with the International Code Council (ICC). ICC certification information is available on-line at: www.iccsafe.org/e/certsearch.htm]. Search for"California UST System Operators." 2. Submit this completed form to the local agency that regulates this facility's USTs. Unidocs member agency jurisdictions and contact information are listed on-line at: www.undoes.org/members/whoregttlateswhathtud. Contact information for other local agencies within California is available at: www.swrcb.ca.gov/Cwphome/Ust/contacts/docstlocal-agency_list.xls. 3. 23 CCR§2715(a)requires that you notify the local agency of any changes to this information within 30 days of the date of change. UN-062.1/I www.unldo org 09/27/05 Received Time Oct. 26, 2012 12:06PM No. 1502