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DEC 06 2006 9:59 RM FR 1761/6 LINCOLN 916 408 0808 TO 17208891011 P.12 <br />uc-TJO—GGGC1 Gc-o� P. 06/07 <br />Owner Statements of Designated Underground Storage Tank (UST) Operator <br />and Understanding of and Compliance with UST Requirements <br />Facility Name,. SAPEWAY NOR CAL #2707 <br />Faoility lD#: 227860 <br />Facility Address: 3425 N. PACIFIC <br />STOCKTON, CA 95207 <br />Recon for Submitting this Form (Check One) <br />❑ Change of Designated Operator <br />Facility Phone #: 209-472-8600 X1219 <br />Expiration Date: 16.31.2008 <br />Update ICC #and/orExpiraziunDac <br />Designated UST Operator(s) for this Facility <br />Primary Mzedoea0 <br />Designated Operator's Name: Dan Moorhead <br />Manan to VST Facility (Chock One) <br />Cl Owner ❑ Opezor ❑ Employee <br />❑ servicrTechnioaa ® Third -Party <br />Business Name (If drfferanr from above): GSlbareaRreeder Raae <br />DecienaredOper2tar'sPhone #:916-947-5285 <br />Intemational Code Council Catitcadon #: 5230115 -UC <br />Expiration Date: 16.31.2008 <br />ALTERNATE 1 (Opilonal) <br />Designated Operator's Name: Jim Palmer <br />Rcledon to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Service Technician ® Third -Parry <br />Business Name (If doerenrfrom above): Gllbarco PeederRoor <br />-Designated Opermor'sPhone #:831-840.5235 <br />Intcreational Code Council C rt:iEeation#: 5254109 -UC <br />Expir6onDate. 02-21.2007 <br />ALTERNATE 2 (Opflonal) <br />Designated Operator's Name: Daniel Pcmz Relation to UST Fscility (Check Om) <br />Business Name (Ifd*eenrfromabove):GllbarcoVaeder•Roor O Owner ❑ Operator ❑ Employee <br />Desippatcd Operator's Phone 0: 9I6-718.0139 ❑ Smice Technioian ® Third -Party <br />Intcmatianal Cede Council Certification#: 5246161 -UC Expiration Date, 11.30-2006 <br />I certify that, for the facility indicated at the top of this page, the individual(s) listed above will <br />serve as Designated UST Operator(s). The individual(s) will conduct and document monthly <br />facility inspections and annual facility employee training, in accordance with California Code of <br />Regulations, title 23, section 2715(c) - (f). <br />Furthermore, I understand and am in compliance with the requirements (statutes, <br />regulations, and local ordinances) applicable to underground storage tanks. <br />NAME OF TANK OWNER (Please Print): WAY NOR CAL - STAN OL,EA <br />SIGNATURE OF TANK OWNER: /%?%% <br />, <br />DATE: 11/10/2006 OWNER'S PHONE: (925) 467.2707 <br />November2004 <br />