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D9/21/2001 01:57 2098325518 <br />Owner Statements of Desig <br />and Understanding ( <br />GRANTLINE BEACON I PAGE 01 <br />E <br />CC, C s <br />C/, l 6 <br />ed Underground Storage Tank (UST) Opera or �4 aC'� %�� <br />nd Compliance with UST Requirements i <br />Farllily Name: 49j, <br />Beeson for S„txnlging tnis Farm fGhe� k <br />Change of Designated Operatornone �o — 33 /3 t] Updaw Cartiflonte Expiation Dato - <br />PRUANY <br />pesignmod Operators Name JANINE KIF <br />Businma Name (If diffeterd iron above)US <br />DeeV,Aerl Opetatofs Phone * : (630) 268 <br />Intamatlonal Code Council Certification I 51A <br />er TFrtWATR rnn#AnnMA <br />Riiatiat to UST Fadgtty' (Cha;k one) <br />O Owner O Employee 13 Service T <br />p Operator ■ 'Fhwd Perin <br />Emiralten oate:10/02/2006 <br />DesignaW Operators Name RANDALL Y <br />Munress Nw m (If diMment from above): UST <br />Relation to UST FociMy (Check ono) <br />U owner O Employee ❑ Service TWon <br />D Operator 6 Third Party <br />gelation to UST FaObty (C�+eCK one) <br />Designalod Operators Phone 0, (830) 268 <br />intentailpnel Code Counrif CerUnca9t n • : 52 <br />Expiration Date: 12/2812006 <br />L) Owner O Emplayee ❑ SerAte T1 <br />ALTERNATE 2 (OpHanaO <br />Designalad Operators Name TERESA KIPJM <br />gelation to UST FaObty (C�+eCK one) <br />13osrness Name (If differant from abo%s): 1387 <br />C <br />L) Owner O Emplayee ❑ SerAte T1 <br />jwmian <br />Designated Oparmket Pht■tiAA <br />0 Opar� 0 Tnird Party <br />Internahmal Code Councir <br />7 -UC <br />Expiration Date 10/23J2Q06 <br />AL76RMATE 3 (Opfion4 <br />Ixslgnated Operators NtaTr>e <br />Relation to U3T Facility (check one) <br />gess Narr a (It drfferaM f <br />0 Owner ❑ Emptaycm O Service T <br />nidan <br />Desgnated Operators Pbone4: 530) 268-$ <br />a Operator ID This Party <br />Intema8wal Cody„ Counoil Cdtiftcabon s : pan*Expiration <br />Dalt@: <br />NOTE: THE LOCAL REGULATORY AGE <br />MUST BE NO'fMIM OF ANY CHANOPS TO THIS INFOR11TTION <br />WITHIN 30 DAYS OF THE CMAN6 <br />I certify that, for the facility mdicated the top of this page, the Individual(g) Hated above wit <br />sere as Designated UST Operator( The individual(s) wi condutat and document monthty <br />facift inspections and anrwat facility mployee training, in accordance with CalHome Code <br />Regulations, title 23. section 2715 ( (f) <br />Furthermore, I understand and a n compliance with the requirements (statutes, <br />reguatlons, and local ordlnances)' tleable to underground storatae tanks. <br />NAME OF TANK OWNER (� <br />OR OWNFR'S AGENT (Pleaw P <br />SIGNATURE OF TANK <br />A., <br />OWNER OR OWNER'S AGENT: �M <br />I} c� <br />DATE: �'-'� rI D' �' NER'S PHONE tt : L(d�- 2-� / q <br />' <br />pc,�� t o� 3 <br />'_00MC7 hind ria• zn TF1 - PPC4R-M- 5.4p NAME: RANBIR k P . 2 <br />