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fforda-Tet 416 2aa Street Phone:(209)744-0112 <br /> Galt,Ca 95632 ' Fax: (209)744-0116 <br /> afforda(aV softeom.net <br /> Owner Statements of Designated Underground Storage Tank Operator <br /> and Understanding of and Compliance with UST Require <br /> Facility Name: Woodbridge Arco AM/PM Facility#: 1552 FfE�D <br /> Address: 18806 Lower Sacramento Road, Woodbridge CA 95258 <br /> Facility Phone#-209-339-8238 ®Change ofDesignated Operam�ov 0 <br /> wondbridgeampmna-,yahoo•com <br /> New Designated Operator <br /> SAN JOAQUIN COUNTY <br /> DESIGNATED UST OPERATOR FOR THIS FACILITY: ENVIRONMENTAL <br /> PRIMARY <br /> HEALTH DEPARTMENT <br /> Designated Operator's Name: ZANENIMMO Service Technician <br /> Business Name: AFFORDA.TEST ICCrl: 5263322-UC <br /> Designated Operator's Phones 209-744-0112 Expiration Date: 3/7J14 <br /> ALTERNATE l <br /> Designated Operator's Name: FELIX RAMIREZ Service technician <br /> Business Name: AFFORDA TEST ICC 5: 52733934-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3/2/14 <br /> ALTERNATE2 <br /> Designated Operator's Name: DAVID WINKLER Service Technician <br /> Business Name: AFFORDA TEST SCC#: ,4263373-UC <br /> Designated Operator's Phone: 209-744-0112 Etpiradou Date: 3/2/14 <br /> ALTERNATE3 <br /> Designated operator's Name: LYLE NIMMO Service Technician <br /> Busium Name: AFFORDA TEST ICC#: 5249115-UC <br /> Designated Operator's Phone: 209-744-0112 Expirstiaa Date: 3/"4 <br /> ALTERNATE4 <br /> Designated Operator's Name: EDWARD STEARNS Service Technician <br /> Rosiness Name: AFFORDA TEST JCC# 5250492-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 1222/12 <br /> I certify than,for the ta�+l'dy iodicamd at tii a ton Of this page.the individuals Ilstad above will snwe sa Designn4d U <br /> ST <br /> Operators. The indlvl awls will e0`10M"•t:100!'OcOment monthly faeiltty Inspections and annual facNkly amp)oyee <br /> training.In <br /> Accordance with California Code 04 Regulations,dHv 23,90tsian 1'"(e)—M' <br /> Furthermore.I uhdtraladd and not In compliance wiih the r"airemco s(statutes,ra#uWriaae,and local <br /> ardiosaees) spplicablcto uodwTi3Ovnd itoralttitnks. L_ ,,((�� ' <br /> INAML OF TANK GWNER(Priw): 1, r'i'd� '.>r.s .can._.. ;® eae, - �OCAL l(7e � AM <br /> SIGNATUREOF7 NKfiWNEA: P- <br /> NMT.? <br /> I� '+L2� _ __ OWNLRLNPHONE: Zg - :fie}-PPa3� <br /> NMT.? <br /> 1! 3[+BM IT'r IBCOMPlRti'fo Tn'A1,AUNCY(NOT SWR('ll)ATTE <br /> ,li1);upOHF.1.sR SIONINC,.THE(ACAL <br /> AGENCY TAS IS AVAIL.AAUr A'I: >.';p.7.1s'a e'bxuda.e�.-aw% 'r'enntar.:coo wr.atml, <br /> 1) N(MEVT ■.1.0(:.AI.A`.r.NCY Ow ANY(IIIAN(;A's 1'rItIR INfORMATR)N WITHIN 30 DAY'S OPTHI; <br /> CHANLK. <br /> OFFICE: �a 8^3 X33 <br /> Cfftyt son 4001"in Ikate xetl: 1 2 Date Sear+Bed1 <br /> I1ate�ma:ied� <br /> t7 .sto�r� �ov�.lAp-C� ZO�� <br />