Laserfiche WebLink
RECEIVED 03/21/2014 14:23 <br /> 03/21/2014 14:33 209992 J0M7RAVELPLAZA PAGE 01/01 <br /> - - — . VV <br /> ED <br /> �b Phnne:(2097744D112 <br /> Ga,relt,ca9501_ <br /> Fax:(2091744 .1116 AP 07 2014 <br /> Gorda-Te t <br /> atf0lda Ifteom.net <br /> atedUnderground5toxsgcTankOpel�atorENVIRO TALHEALTH <br /> t?wnlr Statements aiRs of n uiremertts DE <br /> and Under3tandin of and Cam liancelwx 1383 T � ENT <br /> Is e1 Plaxa Fac- - <br /> CA 95330 Updated Owners statement <br /> kacili. Name: JOeaTrav r �A cmoegnatedOperatnr <br /> A ddreas: 15600 St Harlan Road Lathrop <br /> Facility Phutpe#!;219-982.0370 FO 'r5 <br /> No„ natcd pperator <br /> (31ti T OPE'RA'1 <br /> Service Technician <br /> PRIMARY ZANE N1MMO ICC#: 5263322-UC <br /> neehgdA'�Operator's Name: AFFORDA TEST Expiration Date: 13/16 <br /> 13usineaa Name: <br /> Desi$nattd operator's PRIOR': 209 744 OSt2 <br /> ALTERNATE 1 Service Technician <br /> Z iCC#: 52733934-UC <br /> Designated OPera0r'9 Name: AFkORDA T ST <br /> Expiration D02eo�313116 <br /> )justness Name; <br /> pesignated Operator's Phone 209-744 Ot 12 <br /> ALTERNATE 2Namo: BernICC icke:Techni7c3ia,Un <br /> C <br /> Designated Operntdr's ArFOFDATEST ciplratiortDaa311 <br /> 0/i6 <br /> Business Name- : 209-7440112 <br /> I)esiQnated Operator's Phone <br /> Service Technician <br /> ALTERNATE 3 EDWARD 9TFARNS iCC#: 5250492•UC <br /> oesiRtlated Operator's Name, AFFORDA TEST <br /> e: 209-744--0(1: <br /> me: Expiration Dote: 3!3/16 <br /> Busines <br /> s Nn <br /> Designated Operator's Phon <br /> hat,for the <br /> 1 cnrrlfy tfaelnty indicated at the top of this Pn64 the ladManals listed above will serve xs Designated UST <br /> Op jte t a.The individualP will conduct And document monthly fAcility inspectlnns nod annual feelltty employee <br /> training,In !,[tori,tido 23,section 2715(c)-M- <br /> A <br /> f4 '.. <br /> Aeeordnnce with California Code of Regd <br /> the re uirements(statutes,regulalaoms,and focal ' <br /> Furthermore,I underatand anmpll <br /> d am in coadee with 9 <br /> Ordinances) applicable to underground storage(auks' 11 '•` <br /> NAME OF'PANK OWNER(Print): <br /> SIGNATURE OF T K O <br /> DA'Z'E: OWNERS PHONE: J l•rl <br /> NOTE: <br /> 1) SxiRatIT TRIS CO;NPLETEIIPPRM TO THF LOCAL AOENCX(NtYf swaC)3J AFTER 31GNfiG.TRE tAGAL <br /> AG1;NG t sticMtartWcnnA aeys•html. <br /> v L13T L AVAILARLET AT: .waterhn_ard_s�_.a+"'- <br /> 2) NOTIFY THE LOCAL AGeNt:Y OF ANN GRANGES TO THIS rNFORMATION WITHIN 3f1 PAYS OF THE <br /> CHANGE. <br /> OFFdCF-1 7-/ F Date Scanned: f <br /> County:rjj(_' bate Faxed: N - <br /> Date PrMalled <br /> �Y(aH 3.433 <br /> i <br />