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Jan 21 08 11 : 04a Ffforda Test (209) 744-0116 p• 2 <br /> Tc 19 744 t P.III <br /> JaN-20-2008 12:39 From: v/ <br /> Jan 15 00 04: 03p R4ferda Test: t2091 744-C , I p• 1 <br /> OWner SLR*ements of Designated Underground Storage Tank (L r <br /> and Undemanding of and Compliance with UST Req " <br /> palsy Nur h'.oihty tD r' <br /> rccility - �17y�aJ� W< for'wbodw Irlwlk awj <br /> 70-710 - e S 410IV14,4tt <br /> ,} Chal2m of DC Operator <br /> pgiuTttd UST QprraMr(a)far th� <br /> rRa1MRY <br /> Doiy.rat OWoMm .N.n.c; David A.Winkler ted.rion w US I'h 1 f R oww <br /> Afforda-Test Service icing <br /> nosianu.d On aw.Phone r: 209 744-0112 <br /> b=Mwii ..I Cock Council CaiiOww.n r: 5263373-UC UNIA niop Date: <br /> AILTV"AT9 I 100d..dP <br /> L"cxw sad Opciuor's Na - Z'aoc A.Nimmo --- Rd.tirn.a U1r NIj <br /> nus nca Nwnc(�/di/NAwr!'o�obow): Af1•ord&-Test <br /> Lksipuftd Opmaor,►hoser; ... _...209744-0112 ~ Sm'Yler �' n <br /> tn�tosal Codo(S Wil(•a.elil v ;4n a: 5263322-UC �Kpo�.a(hw- <br /> nprgnnea e>y....mra Nara: 1. l e D.Nimme ' "anon w UST P k fMr/ <br /> tl s NwncV 4k#- .bwx oboved. - Afferda=Pest <br /> 0=00"Open-Des rhano p: 209 744-0112 Service <br /> IPWIwiliop4b Goin Council Cenifau.oa a• 5249115-UC fi.piesl:b.tf p,- /1/4- <br /> 1 cenify that. for the facility;A"cawd at the top of this pate,the indivldtW(s) Me v 11 <br /> serve as Designated us r Operawr(s). "(1m ind Mdua)(s)will conduct and doc L i I moetbly <br /> I*ACilrty inVoctiom and annual facility otnploycc training.in x4ordamm V41h 1 a nia Code of <br /> Regulations,title 23,section 271 S(c)-(1). <br /> Fuet6armore,I understand and m in compliance with the requiremmia i ordes, <br /> MMulaAoos, and local ordiaaisees)applicable to underVVenJ xtorage can <br /> NAME OF TANK O"TR(Plmx rrint): 6e,Ild �. <br /> SIONATURHOFTANK OWNER: Di3r�- • <br /> d� � <br /> ONE#.- <br /> —�. <br /> MTC: F.R'S.HONE#: <br /> Ao2 ( 4 <br /> 0 R r36, es <br /> NOTE: 1)SVHM91 TH&9 COMrLIKT'ED FORM TO THF.LOCAL.AGENCY(NOT ,t TE WATER <br /> RCSOURCRS CONTROL r/OARD)OV JANVARv 1,Zoos.'rMr.IA)CAIL AC' <br /> G1tnY VAILAXLE <br /> AT:wwr!,vlpt_rf(gnrdapa.rQ./ucl/env�etsgypa_3vyc hirci. <br /> Z)NOTTFV 7'"It LOCAL AC9NCY Ov ANV CHANCES TO TItW 00014MATIONIVII, 3V DAY5 <br /> Or THE CNAhI(Mg. <br /> ovwwhwr2004 <br />