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Jan 09 09 12: 14p Afforda-Test ( 209 ) 794-0112 p. l <br /> Jan 09 09 12:10p Skymart Enterpri4 _td 21 ;91756 P.1 <br /> Jan 09 09 11 : 44a Affo.;da-Test: iZOst 794-u1lz P- 1 <br /> Owner Statements of Designated Underground Storage Tank Operator <br /> and Understanding of and Compliance with UST Requirements <br /> P <br /> Facility Faclsty# <br /> ` " = Reason for this form•71-3 , <br /> Facility Phout N: C a <br /> d � � 17 �Xft.Expuatkwi) <br /> DESIGNATED UST OPERA'T'OR FOR TMS FA 11%-. <br /> PRIMARY J AN 4 9 2009 <br /> Designated Operator's Name: LYLE D.NIMMO Service Technician SSAN�OgQifIN COUNTY <br /> Business Tarn: AFFORDA-TEST [cc# 5249I 1NNVIRO'�MENTAL <br /> Designated Operator's Phone# 209 744-0112 Expiration Late; 71112dd`9AUTH DEPARTMENT <br /> ALTERNATE 1 <br /> Designated Operator's Nazac_ DAVID A.WINIQ,ER Service Technician <br /> Business Name: AFFORDA-TE$T ICC ff 5263373 <br /> Designated Operator's Phone 9-: 209 744-0112 EX 0 <br /> ALTERNATE 2 <br /> Designated Operator's Name, ZANEA.NIMMO ServiceTechtri62a <br /> BusincssNamt: AFFORDA-TEST ICC# 5263322 <br /> Designated Operator's Phone#: 209744-0112 Expiration Date: 31142010 <br /> ALTERNATE 3 <br /> Designated Operator's Name. FELIX G.Rq.?MREZ Service Tecfinician <br /> Business Name: AFFORDA-TEST [Cc# 5273934- <br /> Designated Operator's Phone#: 209744--0112 iration Datc_ 62112010 <br /> I certify drat,feu the facility indicated at the top of this page,the individuals listed above will serve as Designated UST <br /> Operators. The individuals will ornuluct and document monthly facility inspections and annual facility employee trainiag,i <br /> accordance with Cafifomia Code of Regulations,tide 23,section 2715(c)-(f). <br /> Fartherruore,X understand and stn in compliance with the requirements(statutes, regulations, and local <br /> ordinances) applicable to underground storage tanks- <br /> NAME OF TANK 0WINER (Print): Z,-�J5,-D <br /> SIGNATURE OF TANK OMWER: <br /> DATE: o D o � j �OWNER'SPHONE. -S/ � � <br /> �voIE: <br /> 1)SU BMIT'TIUSCOMIPLETID FIO,El A TOT HE LOCALAGENCV(NOT STATE WATER RF-90URCES Mf <br /> AFTERSIGNTNG THE LOCALAGENCY LIST IS AVA.ILAB LEAT6- www waterboartis c2.eov24Wcontactslauna aQvs�btrt. <br /> 2)N!OTIFYTHEEOCALAGIENCYOFANYCHANGES TOTHISII`<P'Ot21V]ATIONWMII i30DAI'SOFTHECHAIYG& <br />