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Feb. 2. 2011 9: 17AM D-' ee lump k No. 0358 P. 4 <br /> Stanislaus County <br /> DESIGNATED OPERATOR STATEMENT <br /> I am the "Designated UST Operator" for the following facilities: <br /> Facility Name UST Owner Name Address City <br /> As the "Designated UST Operator', I understand the requirements as noted in Section <br /> 2715(a) of Title 23 of the California Code of Regulations (CCR) and the facilities listed <br /> above are in complaince with all applicable UST requirements. <br /> Printed Name and Title Br-on�r ge-4, ot,, <br /> Signature <br /> Q <br /> ICC "California UST Operator" certificate Number 80/4 G 2? <br /> California UST Operator expiration date ///30/ -�,0lz <br />