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RECEIVEL <br /> AUG 11 2015 <br /> ENVIRONMENTAL. <br /> T' n TF C Ir <br /> ALTERNATE 6 'oval , . <br /> Designated Operator's Name:David Martin Relation to UST Facility(Check One) <br /> Business Name(Ifdifferent from above):Fmmen-Hill Corp. ❑ Owner ❑ <br /> Operator ❑ Employee <br /> Designated Operator's Phone 559-8044618 X Service Technician X Third-Party <br /> International Code Council Certification#:5246124-UC Expiration Date: 10-6-2016 <br /> ALTERNATE 7(Optional) <br /> Designated Operator's Name:James Flowers Relation to UST Facility(Check One) <br /> Business Name(If different from above):Franzen-Hill Inc. ❑ Owner ❑ Operator ❑ Employee <br /> X Service Technician X Third-Party <br /> Designated Operator's Phone#:559-972-5087 <br /> International Code Council Certification#:8036233-UC Expiration Date: 1-8-2017 <br /> I certify that, for the facility indicated at the top of this page, the individual(s)listed above will <br /> serve as Designated UST Operator(s). The individual(s)will conduct and document monthly <br /> facility inspections and annual facility employee training,in accordance with California Code of <br /> Regulations,title 23,section 2715(c)-(f). <br /> Furthermore,I understand and am in compliance with the requirements(statutes, <br /> regulations,and local ordinances)applicable to underground store tanks. <br /> NAME OF TANK OWNER/OPERATOR(Please Print): <br /> SIGNATURE OF TANK OWNER/OPERATOR <br /> DATE: OWNER'S PHONE <br /> NOTE: 1)SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY(NOT THE STATE WATER <br /> RESOURCES CONTROL BOARD)BY JANUARY 1,2005.THE LOCAL AGENCY LIST IS AVAILABLE <br /> AT:www.waterboards.ca-gov/ust/contacts/cupa agys.html. <br /> 2)NOTIFY THE FOCAL AGENCY OF ANY CHANGES TO THUS INFORMATTON WITHIN 30 DAYS <br /> OF THE CHANGE. <br /> Page 2 January 2015 <br />