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APR-24-2013 09:19 FROM:H M:12W-44631170 P.1/1 <br /> fford a-Te t 416 2"Street Phone:(2M 744.011I E IE D <br /> Galt,Ca 95632 Fax:(209)744-0116 <br /> atTortts( sortcom.net <br /> Owner Statements of Designated Underground Storage Tank Operator JUIN t. <br /> 1 ZU13 <br /> and'Understanding of and Com lienee with UST Requirements <br /> Facility Name: United Gas Facility#: POit �'�NVlHUMtN �- <br /> Address: 3440 E Main St Stockton CA 95205 Updated Owners Statement <br /> Facility Phone#: Change of Designated Operator <br /> ❑ New Designated Operatnr <br /> DESIGNAT-ED UST OPERATOR FOR 2M FACILITY: <br /> PRIMARY - <br /> Designated Operator's Name: ZANE N1MMO Service Techniclan <br /> Business Name: AFFORDA TEST 1CCM: 5263322-UC <br /> Designated Operator's Pbouc: 2096744-0112 Expiration Date: 212/14 <br /> ALTERNAT.El <br /> Designated Operator's Namc: FELIX RAMIRIEZ Service Technlciso <br /> Business Name. AFFORDA TEST [CC 0: 52733934-UC <br /> Dosignslcd Operator's Phone: 209-744-0112 Expiration Dole: 31/14 <br /> ALTERNATE2 <br /> Desiunoted Operator's Name: DAVID WINKLER Service Technlciaa <br /> Business Name. AFFORDA TEST 1CC 0: 5263373-UC <br /> DarignaltJ Operator's Phone: 209-744.0112 Expiration Date: 3IM4 <br /> ALTERNATE <br /> Designated Operator's Name, LYLE N1 MMO Service Technician <br /> Business Name: AFFORDA TEST ice a: 52491 15-M <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 32/1,4 <br /> ALTERNATE4 <br /> Designuted Operator's Nome: EDWARD b-PrEARNS Service'rechnician <br /> Dusincas Nome AFFORDA TEST ICC 0 52.40M2 VC <br /> Pcatgnatcd Operator's Phone: 209744-0112 Expiration Dote: 12119/14 <br /> 1 certify that,for the facility indicated at the top of this page,the individuals listed above will serve as Designated UST <br /> Operstor<. The Individuals will conduct and document monthly facility inspections and annual facility employee <br /> training.in <br /> Accordance with California Code of Regulations,title 23,section 271.5(c)-(n. <br /> Furthermore,i understand and am in compliance with the requirements(statutes.regulations,and local <br /> Ordinances) applicable to underground storage tanks. <br /> NAME OF TANK OWNER(Print):Jean H . Lee <br /> SICNATURE OPTANK OWNER: lean H. Lee <br /> DATE:April 23, 201.3 OWNS PHONE:650-941-ID'S—�. <br /> 1852 <br /> NOTE: <br /> 1) SUBMIT THIS COMPI.B'rED FORM To T"K LOCAI.AGBNCV(NOT SWACB)Ai MIt SIGN(NG.1-14C LOCAL <br /> AGENCY LISTU AVAILABLE.ATt www walerboards es,Lwv/ust/contsewcuoa flus html, <br /> 2) NOT1b'Y THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION W rINM 30.DAYS OF THF, <br /> CHANGE. <br /> OFFICE: <br /> County: Date Faxed: Date Scanned: <br /> Date E-Mulled <br />