Laserfiche WebLink
2nd Stmt <br />)phones (209) 744-0112 <br />rdMfoaT^�416 <br />Gslt, CA 93632 <br />Fax: (209 7440'116 <br />afford <br />icer Statement9 of DeslUuuted Undeirgroand Storage Tank Operator <br />and UnderstaAding of and Com fiance with <br />UST Regnirements <br />Facility )`tames Fast N ay Fac17- #: 16 <br />lP09 <br />Address: 1399 E. Yosemite Manteca,Ca. 95336 <br />Updated Owners Stattsrvent <br />Facifity Phone 3 <br />Change ntDerignated.aperaeor <br />[a New Dmigoatd opetafor <br />nI>'SIGNA UST O FRAJQ1% 1FOR TIEIS <br />ACIILT E <br />t'ktIS�AItY <br />Deftp utcd Operator's Name: ZANE NI1r1M0 <br />Sew=Tectmiwa <br />Businew Mune AFF ORDA TEST <br />ICC#: 6263322 -UC <br />1lesignatea Operator's Phonx 2119-7440112 <br />Expiration Datk-, 3/2!%4 <br />ALTERNATE 1 <br />Dcaigsuted Operator's Name: FELIX RAA'ITIiIrZ <br />Service Temnicko <br />SaslncasNaroa- AFFORDATEST <br />ICC #: 52733934 -UC <br />Designated operator's rhona= 20-744-0112 <br />Expannon Date: 3a44 <br />ALTERNATE 2 <br />Daigaated Operatosle Name DAVID WL1vKL'Vt <br />Service Teauldan <br />Rdsinm Name A.FFORP.A T ZEST <br />ICC #: 526337.1 -UC <br />Detignatcd OpesatWs Phone: Z09.744.0712 <br />Expiration Dates 312114 <br />ALTERNATE 3 <br />Dalgoted Owatar's Name: LYLE NtMMU <br />Service Techniti <br />Bnainess Noma AFi'ORDA TEST <br />ICC #: 57x911"C <br />De9lgnatcd OpervM," s PhoaC 209-744.0112 <br />ExpR*stion patr. 3/2/14 <br />ALTERNATE 4 <br />Defeated Operator's Name: EDWARD SPEARNS <br />ServiceTe!MlCMn <br />BusioaSName: AFi<ORDA TEST <br />ICC# 5250492 -UC <br />Designated Operator's Phouc: 209-744-0112 <br />Expiration Date: 12 114 <br />I certify that, forth* 13aco* hrdieated at the top of this Fage, the individuals fisted above will serve as Designated UST <br />Operators. The individuals will conduct and document monthly facility io"Ipectiosu and annual facility employee <br />training, in <br />Aeeordancs with California Code of Regulations, title 23, sectlon 2713 (c) — (t). <br />Fnrthermore, X understand and am in compliance with the requirements (statutes, regulations, and local <br />Ordinances) appl'rcabloto ondtrgrottad atoragc tanks. PJ A � v 0 M R A <br />NAME OF TANK OWNER mint): V I k a My o/%J w i2 z!1 V t <br />SIGNATURE OF TANK OWNER T~ jLC. rra gar_ <br />DATE: �i -Z 3 OWNERS PHONE: s s� 2) oLt 59 <br />Noel:: <br />1) SUM41T THIS COMEPLEM FORM TO THE LOCAL AGENCY (NOT SWRCB) AFTER SIGNING. THE LOCAL <br />AGENCY LIST IS AVAMABI E,AT, �.�+sterboerda m.goyLoltLCMahct*1Clin$ s�htsnl. <br />2) NOTVV THE LOCAL. AGENCY OF ANY CITANOM TO TRIS I NTOPUNIATION WITHIN 30 DAYS OA TM <br />C9ANGE. <br />ax�rc�: <br />Ooanty: Date Faxed: Y Date Scanned - <br />Date &Mailed , <br />b0/b0 39Vd 9T AS3 N SSV -J VZVEEZ860ZT TS:8T 6TOZ/5T/80 <br />