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ffordil-Tet ! ,,,t,,, 9,6.24162"d Street Phone: (209)744-0112 <br /> Fax: (209)744-0116 <br /> affordaCmsofteom.net <br /> Owner Statements of Designated Underground Storage Tank Operator <br /> and Understanding of and Compliance with UST Requirements <br /> Facility Name: Woodbridge Arco AM/PM Facility#: 1552 <br /> Address: 18806 Lower Sacramento Road, Woodbridge CA 95258 <br /> Facility Phone#:209-339-8238 ® Change of Designated Operator <br /> wwdbridgcampnV,4.yahoo.com <br /> ❑ New Designated Operator <br /> DESIGNATED UST OPERATOR FOR TIIIS FACILITY: <br /> PRIMARY <br /> Designated Operator's Name: ZANENIMMO Service Tromiciao <br /> Business Name: AFFORDA TEST ICC#: 5263322•UC <br /> Designated Operator's Phone: 269-744-6111 Expiration Date: 3PJI4 <br /> ALTERNATEI <br /> Designated Operator's Name; FEIAXRAMIREZ Service Technician <br /> Business Name: AFFORDA TEST ]CC 0: 52733934-1:C <br /> Designated Operator's Phone: 269.144-0112 Expiration Date: 31114 <br /> ALTERNATE2 <br /> Designsttd Operators Name: DAVID W INKLER Service Technician <br /> Business Name: AFFORDA TEST lCC#: 5263373-UC <br /> Designated Operator's Phone: 209.744-0112 Expiration Date: 3MI4 <br /> ALTERNATE3 <br /> Desigaated Operator's Name: LYLE NIMMO Servtee'lechnichm <br /> Business Name: .AFFORDA TEST ICC#: 5249115-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3x,1.4 <br /> ALTERNATE4 <br /> Designated Operator's Name: EDWARD STEARYS Service Techuldan <br /> Business Name: AFFORDA TEST ICC# 5256491-Uc <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 12MI12 <br /> I certify that,for the facility Indicated at littoo of khis page,the individuals lasted above will serve of Daisanad LIST <br /> Operators, The Individuals will ivildu^.t CIO,+ocnment month` 14011ty i0fitwons and annual Notify employee <br /> training,in <br /> Accordance with California Code of Reyulationx.tine Y.S.section 2711,(e)-(f). <br /> furthermore.I understand and nm in compliance with the requnemanty(statutes.regulations,and local <br /> Ordtnmcn) applicable to uadaryrau hd stnrassanks. r <br /> NAME OF TANK(}WNER(Print): S�Y � �c dj�Q tx)aodbrtdf� �'1�M <br /> SIGNATURE OF TANKOWNCk: <br /> DATE: �_1( fLz_= OWNERS PHONE: ZoT- :33%� d'a3p <br /> N(Tx• <br /> 1) SIiBMIT-f IBCYiMPi,Ef"KU4'csptt'fOTs(P.i.(a'At.Ai,ENCY(NOTSWR(IDAFTER SIGNLNG,THE LOCAL <br /> AGENCY IA IS AVAIlAMt A's: jiuVZ dtst&aS� me"ps.3r�3,8I>K6 <br /> 1) N(MFV TaE L0CAI.At7FACv'(le ANY('IIANt;NS'1'0IDS lNPORM1 TION W'IT'ION 30 DAYS OF FHE <br /> CHANV.. <br /> OFFICE: <br /> Cuuntys Son Jossivin Data Axed: Dace$earned: <br /> IYate�mn;ied ; <br /> To <br /> , s,,4 Jn�Y tri r tE 2OlJ <br />