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May 29 14 06:50a Covey Enginepring Inc 8667068265 p.2 RECEIVED !Ay 2 9 20114 Owner Statements of Designated Underground Storage Tank(UST) Operator and Understanding of and Compliance with UST RequiremenLENVIRONMENTAL HEALTH DEPARTMENT Facility Name:YRC Freight Facility lD#: FA0003854 Facility Address: 1535 Pescadem Ave-Tracy,CA 95304 Reason for Submitting this Form(Check One) X Change of Designated Operator Facility Phone C 209&33.1300. ❑ Update Certificate Expiration Date Designated UST Operator(s)for this Facility PRIMARY Designated Operator's Namr.Scott R.Covey Relation to VST Facility(Check One) Business Name(Ifdifferemfram above):Covey Engineering Inc. ❑ Owner ❑ Operator ❑ Employee Designated Opetator'sPhone#:951-522-5110 ❑ Service Technician X Third-Party International Code Council CedTwation#:5252466 Expiration Date 6-25-2015 ALTERNATE I tiauaf Desigmred Operator's Name: tcooC tjoA,1? Relation to UST Facility(Check One) Business Name(ifdgferentfrom above): ❑ Owner ❑ Operator ❑ Employee Designated Operator's?how It: SiC>- ?.%44 - 4ZZa ❑ Service Technician XThird-Party International Code Council Certda;ation#: 5 Z 3 q•}t(y Expiration Date: 7-19 ALTERNATE (Optional) ^ Designated Operator's Name: Relation to UST Facility(Check One) Basiness Name(ff dtpereat from above): Cl Owner ❑ Opomtor ❑ Employee Designated Operator's Phone#: ❑ Service Technician ❑ Third-Party International Cade Coursed 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 requirements(statutes, regulations,and local ordinances)applicable.to underground storage tanks. NAME OF TANK OWNER(Please Print):Pia Le SIGNATURE OF TANK OWNER- DATE: WNER-DATE: ( OWNER'S PHONE P: il3 ''3y`f-36�� NOTE: 1)SUBMIT TITS COMPLETED FORM TO THE CUPA. 2)NOTIFY THE,LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE.