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Owner Statements of Designated Undergrow age Tank (UST) Operator and Understanding of and Cc nce with UST Requirements — continued ALTF.RNATF. 1 Mntiona0 Designated Operator's Name: Blake Hemess Relation to UST Facility (Check One) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician ❑x Third -Party Business Name (Ifdifferentfrom above): GilbarcolVeeder-Root Designated Operator's Phone #: 8001253-8054 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) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician ❑X Third -Party Business Name (Ifdifferent from above): Gilbarco/Veeder-Root Designated Operator's Phone #: 800/ 253-8054 International Code Council Certification #: 5243667 -UC Expiration Date: 10/312006 ALTERNATE 3 (Optional) Designated Operator's Name: Daniel Perez Relation to UST Facility (Check One) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician I] Third -Party Business Name(Ifdifferentfrom above): Gilbarco/Veeder-Root Designated Operator's Phone #: 800/ 253-8054 International Code Council Certification #: 5246161 -UC Expiration Date: 11/302006 ALTERNATE 4 (Optional) Designated Operator's Name: Darrell Riley Relation to UST Facility (Check One) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician I@ Third -Patty Business Name (Ifd fferent from above): Gilbarco/Veeder-Root Designated Operator's Phone #: 800/ 253-8054 International Code Council Certification #: Not Available Expiration Date: Not Available ALTERNATE 5 (Optional) Designated Operator's Name: Darren L Austin Relation to UST Facility (Check One) ❑ Owner , ❑ Operator ❑ Employee ❑ Service Technician O Third -Party Business Name (Ifdifferentfrom above): Gilbarco/Veeder-Root Designated Operator's Phone #: 800/ 253-8054 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) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician ❑x Third -Party Business Name (Ifd fferentfrom above): Gilbarco/Veeder--Root Designated Operator's Phone#: 800/ 253-8054 International Code Council Certification #: Not Available Expiration Date: Not Available ALTERNATE 7 (Optional) Designated Operator's Name: Rayne Guttman Relation to UST Facility (Check One) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician O Third -Party Business Name (Ifd fferent from above): Gilbarco/Veeder-Root Designated Operator's Phone #: 800/ 253-8054 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) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician ❑x Third -Party Business Name (If d fferentfrom above): Gilbarco/Veeder-Root Designated Operator's Phone #: 800/ 253-8054 International Code Council Certification P. 5243829 -UC Expiration Date: 10/31/2006