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FROM MARIGOLDSHELL <br /> auua V0,11 1%,jo ?An PHON>= NO. = 209 952 4862 1,1 2009 02:11PM P1 <br /> &WvuL <br /> AUG 1 12009 <br /> Affords-Te$t 416 2nd Street Galt,Co. 209 744-0113 309 744-91.16 FAX <br /> Owner Stattielaients of DeSilgnsat ed Underground Storage Tank 1Dperaltur <br /> and Understanding of and Complianee with UST Regairo>rl '041ts <br /> iC afie: <br /> PacTrty*; <br /> A4tf�'mct <br /> Fo i—ff IF;form: <br /> Facility Phone fl: C is Change of Designetod Operator <br /> Update CeKf tatc EVirstion pate <br /> PRIMARYAL"SIr-HATED UST OPERATOR FOR THIS FAC Lin; <br /> D"411nted Operator's Name, LYLE D.ND4MO Service Technician <br /> I3aeinesa Name: AFFORDA-TtST 1CC# <br /> 5249115 <br /> De s A erarnr'y Photar fit: lily 744-0112 <br /> 8xp1racun Data; 'f; ftpoA�,1�„ <br /> ALXERNATE 1 <br /> D0619110ed Opafltor's No e, DAVID A.'(J/'INKLER Service Technician <br /> 8ulgirnesd Nam. A FFORDA-TEST <br /> Dr-sjW ated *star's phone 6 209 14"112 1CC 5263373• <br /> ALTERNATE 2 .3/27/2019 <br /> twclgra"d 17porator's Name: ZANZ A.NINNO <br /> Service Technician <br /> Businme Namne: AFFORDA-TIES 3' <br /> ICC fi 5263322. <br /> Decimated operator's phone rt: 200744-0112 <br /> AL.T1wRN',4►Tz s Fsx iration Date: 3/14/?A I✓J <br /> DcsltnatedOpmawr's Name, FELLX a RA IREz Service TbeluzieiAn <br /> Sett Ines Natne- APFORDA-TR$T !Cc $273934 <br /> Designated Opa arx's phone�+; 209744-0112 PA2irndon 2M &21/2010 <br /> 1 <br /> owilyat,for Inc T40111ty ird76atedat a Mp of this page,the Wi;ldumlsn1lbovs wit save ea Des <br /> Oparatore, The individoels will conduct and dooamont monthly facility inspections and annual facilityem `gtmt>od US <br /> sccvrdance with C4H(bmis Code of Regulations,title 23.sfttion 2715(c)-(f). P traitlinS,In <br /> Furtherblare, X raderstapd and alb is compliadce with the reyulrememta (statutes, regulations, and focal <br /> ardinaneea) aPPlloable m aadergtrou:gd staraw tanlca. <br /> NAME (W TANK OWNER (Print)l ­V � — <br /> St(;NATURE OF TANK Oy1r�rRtC� <br /> DATE: —49 <br /> 10 f3 <br /> Nm.. <br /> 1)SLgMTT141SCOMPLETEDFORM TOTRRLOCA ACENCY(NOTSTATBwA'I AE.SOL=86CONTROL.BOARD)APTBR <br /> SIOWN(I THE LOCAL AOENCYLIST ISAVAILABLE AT; www,watpl�r�,osi.gov/aadcontaelycupaLpaye.11tm1, <br /> 2)NOTIFX3'4E L OCALAOB�-JCY OFAt�YCHANGESTO T14T$rtTFORMATION WITNtIty 30 D,ayS OFTI tB CFiANdu. <br /> TOO[n Hars TFd CT:ST TT/80 6002 <br />