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Apr 29 09 01 : 00p Afforda-Test (209) 794-0112 p. l J\)J <br /> Jan 09 09 12:10p Skymart Enterpr Ltd " . . ). 9?;756 p.1 I� <br /> Jan IIS 09 21 : 448 Rfforda-Test <br /> APR 2 9 2000 '��� <br /> SAN JOPADUIN COUNTY <br /> Owner Statements of Designated Underground Storage Tank Operator <br /> and Understanding of and Com�iiai,'6e'�th UST Requirements <br /> Facility Name: i„G 11?f} -T�./•B�!/ PRI �" �/fJ� FaclSty# <br /> Address: 13 �L G�?, 1C S�, .��C /J Rr�son for this forn: <br /> /��/ X Change of Designated Operator <br /> Facility Phone#: -' 0 �`�` C? UpdreCertifiram Expiration Date <br /> DESIGNATE UST OPERATOR FOR THIS FACIUT'Y: <br /> PRIMARX <br /> Dcsiguated Operator's Name: LYLE D.NIMMO Service Technician <br /> Bwinesss Name- AFFORDQA-TM [cc# 5249115 <br /> Designated Operator's Phone#: 209744-0112 Expiration Date: 7/1/2009 <br /> ALTERNATE 1 <br /> Designated Operator`sNamc: DAVID A.WINKx,ER Service Technician <br /> Business Name: AFFORDA-TEST TCC# 5263373 <br /> Designatod Operator's Phone#: 209 744-40112 Ex 3/27,'2010 <br /> ALTERNATE 2 <br /> Designated Operator's Name: ZANEA.NIl4EMO ScrviceTechnician <br /> BusincssName: AFFORDA-TEST CCC# 5263322 <br /> Designated Operator's Phone At 209744-01[2 Expiration Date: 3114/20[4 <br /> ALTERNATE 3 <br /> Designated Operator's Name: FELIX Q RAMIEXtEZ Service Technician <br /> Busincss Name: AFFORDA-TEST ICC# 5273934 <br /> Desig atcd Operator's Phone#: 209744-0112 1 Fxpiration Dal--: 612112010 <br /> 1 certify that,for the facility indicated at the top of this page,the individuals listed above wilt serve as Designated UST <br /> Opetatars. The individuals wi8 conduct and document monthly facility inspections and annual facility cmmployce trainin&i <br /> accordance with California Code of Regulations,tide 23,section 2715(c)-(f). <br /> Furthermore,I uader3taxad and ata in compliance with the requirements(statutes, regulations, and local <br /> ordinances) applicable to underground storage tanks_ <br /> NAA'IE OF TANK OWNER(Print): <br /> SIGNATURE OF TANK OWNER: <br /> DATE: D OWNER'S PHONE <br /> �iUIE: <br /> l)SUBMITTHISCOWLETEDFOJEtMTOTRELOC4JLA.GENCV(NOTSI'ATFWATERR1MURCISGOKMOLBOARD) <br /> AFTER 514GNMG THE LOCALAGENCY UST 15 AVA1LA 8 LEAT.- w+r w waMrlroards.ca ggvlucVcontacWcupe aevs—W <br /> 2)N=rYTHE LOCALAGF iCY OFANY CHANCES-rO THIS INFCORMATlON 1't Mf IN 30 DAYS OFTHE CHANGE. <br />