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ACfforda-T tt 4162 "d Street Phone: (209) 744-0112 <br />Galt, Ca 95632 Fax: (209) 744-0116 <br />a fforda(a)softcom.net <br />Owner Statements of Designated Underground Storage Tank Operator <br />and Understanding of and Compliance with UST Requirements <br />Facility Name: Fast N Esy Facility #: 16 PO# <br />Address: 1399E. Yosemite Manteca,Ca. 95336 Updated Owners Statement <br />Facility Phone #: ® Change of Designated Operator <br />❑ New Designated Operator <br />DESIGNATED UST OPERATOR FOR THIS FACILITY: <br />PRIMARY <br />Designated Operator's Name: <br />ZANE NIMMO <br />Service Technician <br />Business Name: <br />AFFORDA TEST <br />ICC #: 526332241C <br />Designated Operator's Phone: <br />209-744-0112 <br />Expiration Date: 3/2/14 <br />ALTERNATE 1 <br />Designated Operator's Name: <br />FELIX RAMIREZ <br />Service Technician <br />Business Name: <br />AFFORDA TEST <br />ICC #: 52733934 -UC <br />Designated Operator's Phone: <br />209-744-0112 <br />Expiration Date: 3/2/14 <br />ALTERNATE 2 <br />Designated Operator's Name: <br />DAVID W INKLER <br />Service Technician <br />Business Name: <br />AFFORDA TEST <br />ICC #: 526337341C <br />Designated Operator's Phone: <br />209-744-0112 <br />Expiration Date: 3/2/14 <br />ALTERNATE 3 <br />Designated Operator's Name: LYLE NIMMO Service Technician <br />Business Name: AFFORDA TEST ICC #: 5249115-11C <br />Designated Operator's Phone: 209-744-0112 Expiration Date: 3/2/14 <br />ALTERNATE 4 <br />Designated Operator's Name: EDWARD STEARNS Service Technician <br />Business Name: AFFORDA TEST ICC # 5250492 -UC <br />Designated Operator's Phone: 209-744-0112 Expiration Date: 12/29/14 <br />I certify that, for the facility indicated at the top of this page, the individuals listed above will serve as Designated UST <br />Operators. The individuals will conduct and document monthly facility inspections and annual facility employee <br />training, in <br />Accordance with California Code of Regulations, title 23, section 2715 (c) - (f). <br />Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local <br />Ordinances) applicable to underground storage tanks. <br />NAME OF TANK OWNER (Print): V AM V 0 H 12 Al� Y v b H R A <br />4 jL-�� <br />SIGNATURE OF TANK OWNER: <br />DATE: -7--2-2013 OWNERS PHONE: S Sq 2 l ©% Sc3 <br />NOTE: <br />1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT SWRCB) AFTER SIGNING. THE LOCAL <br />AGENCY LIST IS AVAILABLE AT: www.waterboards.ca.gov/ust/contacts/cepa agvs.html. <br />2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE <br />CHANGE. <br />OFFICE: <br />County: Date Faxed: 7-L-2ci 3 Date Scanned: '7-2-203 <br />Date E -Mailed 7-2-203 <br />