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Owner Statements of esignated Underground StoragePaank UST Operator and Understanding of and Compliance with UST Requirements r ity Name:7-Eleven#32190 Facility ID#:ity Address: 4943 S. State Route 99, Stockton Reason for Submitting this Form(Check One) ❑ Change of Designated Operator ity Phone#: 209-939-0679 ❑ Update Certificate Expiration Date Designated UST Operator(s) for this Facilitv PRIMARY Designated Operator's Name:Daniel Perez Relation to UST Facility(Check One) Business Name(Ifdierentfrom above): Gilbarco-VeederRoot ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:303-986-8011 ❑ Service Technician j(Third-Party Intemational Code Council Certification#: Expiration Date: ALTERNATE (Optional) Designated Operator's Name:Marla Murphy Relation to UST Facility(Check One) Business Name(Ifiliferentfrom above): 7-Eleven,Inc. ❑ Owner ❑ Operator XEmployee Designated Operator's Phone#: 925-699-9795 ❑ Service Technician ❑ Third-Party International Code Council Certification#: Expiration Date: ALTERNATE (Optional) Designated Operator's Name:Robert Clemens Relation to UST Facility(Check One) Business Name(If differentfrom above): 7-Eleven,Inc. ❑ Owner ❑ Operator Employee Designated Operator's Phone#:714-394-6005 ❑ Service Technician ❑ Third-Party International Code Council Certification#:5232613-uc Expiration Date:4/23/2006 ALTERNATE (Optional) Designated Operator's Name:Darren Austin Relation to UST Facility(Check One) Business Name(Ifdiiferent from above): Gilbarco-VeederRoot ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:303-986-8011 ❑ Service Technician Third-Party International Code Council Certification#: Expiration Date: ALTERNATE (Optional) Designated Operator's Name:Darryll Riley Relation to UST Facility(Check One) Business Name(Ifdifferent from above):Gilbarco-VeederRoot ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:303-986-8011 ❑ Service Technician Third-Party International Code Council Certification#: Expiration Date: I certify that,for the facility indicated at the top of this page, the individual(s)listed above will serve as Designated UST Operator(s). The individual(s)will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations,title 23,section 2715(c)-(f). Furthermore,I understand and am in compliance with the uirements(statutes,regulations,and local ordinances)applicable to underground storage tanks. NAME OF TANK OWNER(Please Print): n artin SIGNATURE OFTA OWNER: DATE: 2 /6 n OWNER'S PHONE#:253-796-7170