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Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name:Pacific Gas&Electric Company—Stockton Service Center Facility ID#: Facility Address: 4040 West Lane Reason for Submitting this Form(Check One) Stockton,CA 95204 X Change of Designated Operator Facility Phone#: 209-942-1566 ❑ Update Certificate Expiration Date Designated UST Operator(s) for this Facility PRIMARY Designated Operator's Name: Michelle Le Relation to UST Facility(Check One) Business Name(Ifdierent from above): ❑ Owner ❑ Operator X Employee Designated Operator's Phone#: 209-942-1566 ❑ Service Technician ❑ Third-Party Intemational Code Council Certification#: See attached Computer Exam Report Expiration Date: 08/13/09 ALTERNATE 1(Optional) Designated Operator's Name: Wayne Pacheco Relation to UST Facility(Check One) Business Name(Ifdifferent from above): ❑ Owner ❑ Operator X Employee Designated Operator's Phone#: 209-576-6532 ❑ Service Technician ❑ Third-Party International Code Council Certification#: 5245801-UC Expiration Date: 11/1/2008 ALTERNATE 2 (Optional) Designated Operator's Name: Relation to UST Facility(Check One) Business Name(Ifdierent from above): D Owner ❑ Operator ❑ Employee Designated Operator's Phone#: ❑ 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) - (1). 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): SIGNATURE OF TANK OWNER: DATE: OWNER'S PHONE#: NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY(NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ca.gov/ust/contacts/cupa agtivs.html. 2)NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE.