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RECLIVED 03113/201.4 19:12 <br /> Mar 13 14 07:04p Alpha Gas 20 569 .1 <br /> C;'FIVEI <br /> ifords x}16 2'°d Street Fbanes(209)744-0112 APR 0 7 2014 <br /> a-Te Galt,Ca 95632 Ii'ax: (209)744-0116 11 <br /> Affordx Irx ftcam-net ENTAL HEAL <br /> Owner Statements of Designated Uridcrgroulnd Storage Tank Operator DEPARTMENT <br /> and Understaudin of and Conn Bance witb USS'Pe uirements <br /> �+acility Name �illaa Fast gas <br /> Facility#: P(A <br /> Adds-ess•-Ls$'013*EtiVatertoo Starktou CA Updated Owners Statement <br /> Facility Phone 9' Z49-4b2-1511i ❑Challge of pesignattd OperatDr <br /> [1 <br /> New Deai0Ated apefator <br /> DESIG ATE)D US OP T R F R S FACIL TY: <br /> FWNIARX StrvlceTtchnleian <br /> t7esigngfedOperntoesN2me- Z.ANENIMMO ECC# 525331:-CTC <br /> BEsioass Name: AYfORDA IMST <br /> E:xpirAtlan Daft: <br /> De&;gtlatedOperatbr'9Pb03*'- 2D �k ElllZ <br /> 317J14 <br /> AL-JERNATE 3 ServictTechaidan <br /> D�slgoatCtlOperator's?iame: FELIXlLAi1I fCC#i 52733934-UC <br /> HnsineasN�tno: ATFO RDA TEST Expiration 09te: 3/6/16 <br /> Dtsigoatcd 0[terator's Ph6ac: 209-744-0112 <br /> ALTI&XNAT92 Service Tfbflki.atn <br /> Designawd 011e WTt s NA r.. DAVID NNWKLER [cc#: 52633'73-ILC <br /> SudiatsSlSame: AFFOItDA TEST <br /> %resign and Opete tor's Ptrone: 3U9-744.011? <br /> Fxpir�ltan�dit; 311:4116 <br /> ALTERNATE 3 <br /> Rerrlcc''�eshni tign <br /> nesigaattd Opergtor's*Ixme, Et7'jVAP.V 3TPARNS 1CC e 5?50492-liG <br /> WiLmincss Vame; AFFORDA QST <br /> DeAiguatCd t]1+ers;tor's Phana: ?.09-7#4-oJ.12 <br /> H.XPirgGOn Dnir 315116 <br /> I certlty that,for tnt facility lagR ated at the top of ibis page,the individuals listed a"ve ryitl serve as Designated LST <br /> <)peratam The Individuals will.rcmduct and document at <br /> #acltltg ipspsrtions and-annual facfltty atttployee <br /> training,in <br /> A rdance with CAlifornix Code of it guliations,title 7�,sectlan 27t 5(0 {f). <br /> Furthermore,[uodcrstnnd and'A01 in MmPtiazlrc with the rstluh-eu1Mt3(Statutes,rtgulsti"S,and local <br /> Ordinances) 21pplieatle to underground storage tanks. <br /> NA14E OF TANK OWNEWOperator(Print). 171r,HP, <br /> SIGNA•I'Cl'[tE OF TANK OWNER/Operator t <br /> DATE. o - OOWNFIRS PHONE: ' <br /> NOTE: AFTER SXGNENOTHELO CAL <br /> 1} SI:Bh1fi'T,Ii1S Cf3NfPLE'S7EUFOR�Ivi TO T139 Lor-ALAGENCY(NOT SWRCB) . , <br /> Orr I+CY tl XST 15 AVAILABLE AT: c�ww,lM1atcrhnarYis ea a��G4L1-Etta/cvRs agys•Ciiml• <br /> '8) NOTIpy THE LOCAL AGENCY Ort'ANY CHA4NGES To THIS ©RMA'TION°4 I T1FLIN 30 DAYS OF TKT <br /> CH'ANGL <br /> OFFICE: 17ate Scanaecl'. <br /> County: Date 3 axed: ' <br />