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by <br /> BP West Coast Products LLC <br /> 4 Centerpointe Drive <br /> La Palma,CA 90623 <br /> E�4 __. <br /> PERMf 1/SERVICES <br /> Owner Statements of Designated Underground Storage Tank (UST) Operator <br /> and Understanding of Compliance with UST Requirements <br /> Facility Name:ARCO-4932 Facility ID#: <br /> Facility Addlgss: Reason for Submitting this Form(Check One) <br /> STOCKTON,CA'M- X Change of Designated Operator <br /> Facility Phone#:209-466-9516 ❑ Update Certificate Expiration Date <br /> Designated UST Operator(s) for this Facility <br /> PRIMARY <br /> Designated Operator's Name:James Cusick Relation to UST Facility(Check One) <br /> Business Name(If different from above):Delta Environmental Consultants,Inc. ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:916-601-9337 ❑ Service Technician X Third-Party <br /> International Code Council Certification#: Temporary Certificate Expiration Date: 12/18/2006 <br /> ALTERNATE 1 (Optional) <br /> Designated Operator's Name:refer to backup document Relation to UST Facility(Check One) <br /> Business Name(If different from above):refer to backup document ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:refer to backup document ❑ Service Technician X Third-Party <br /> International Code Council Certification#:refer to backup document Expiration Date:refer to backup document <br /> ALTERNATE 2 (Optional) <br /> Designated Operator's Name:refer to backup document Relation to UST Facility(Check One) <br /> Business Name(If different from above):refer to backup document ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:refer to backup document ❑ Service Technician X Third-Party <br /> International Code Council Certification#:refer to backup document Expiration Date:refer to backup document <br /> I certify that, for the facility indicated at the top of this page,the individual(s)listed above will <br /> serve as Designated UST Operator(s). The individual(s)will conduct and document monthly <br /> facility inspections and annual facility employee training, in accordance with California Code of <br /> Regulations,title 23, section 2715(c)- (f). <br /> Name of tank Owner(print): Chris Moul <br /> Signature of Tank Owner: '?,�Z/- <br /> Date: 12/22/2004 Owner's Phone# (714) 690-2349 <br /> In December 2004, BP West Coast Products, LLC submitted a separate letter to the local <br /> agencies documenting compliance with UST regulations. A copy of this letter can be made <br /> available upon request. <br /> November 2004 <br />