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Owner Statements of Designated Undergrot orage Tank(UST)Operator and Understanding of and C ance with UST Requirements—continued ALTERNATE 1(Optional) Designated Operator's Name:Blake Herness Relation to UST Facility(Check One) Business Name(If different from above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#: 800/253-8054 ❑ Service Technician 0 Third-Party International Code Council Certification#:Not Available Expiration Date:Not Available ALTERNATE 2 (Optional) Designated Operator's Name:Cindy Padden Larson Relation to UST Facility(Check One) Business Name(If different from above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#: 800/253-8054 ❑ Service Technician F) Third-Party International Code Council Certification#:5243667-UC Expiration Date: 10/31/2006 ALTERNATE 3 (Optional) Designated Operator's Name:Daniel Perez Relation to UST Facility(Check One) Business Name(If dierent from above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:800/253-8054 ❑ Service Technician 0 Third-Pasty International Code Council Certification M 5246161-UC Expiration Date: 11/30/2006 ALTERNATE 4 (Optional) Designated Operator's Name:Darrell Riley Relation to UST Facility(Check One) Business Name(If different from above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone M 800/253-8054 ❑ Service Technician 0 Third-Party International Code Council Certification M Not Available Expiration Date:Not Available ALTERNATE 5 (Optional) Designated Operator's Name:Darren J.Austin Relation to UST Facility(Check One) Business Name(If different from above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone M 800/253-8054 ❑ Service Technician 0 Third-Party International Code Council Certification#:Not Available Expiration Date:Not Available ALTERNATE 6 (Optional) Designated Operator's Name:Eric Banghart Relation to UST Facility(Check One) Business Name(If different from above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:800/253-8054 ❑ Service Technician 0 Third-Party International Code Council Certification#:Not Available Expiration Date:Not Available ALTERNATE 7 (Optional) Designated Operator's Name:Rayna Guttman Relation to UST Facility(Check One) Business Name(If different from above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#: 800/253-8054 ❑ Service Technician 0 Third-Party International Code Council Certification#:5245973-UC Expiration Date: 11/16/2006 ALTERNATE 8 (Optional) Designated Operator's Name:Ron Larson Relation to UST Facility(Check One) Business Name(If different from above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#: 800/253-8054 ❑ Service Technician 0 Third-Party International Code Council Certification#:5243829-UC Expiration Date: 10/31/2006