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Apr 02 12 09:45a AFFORDA TEST 209-744-0116 p.1 <br /> SEp. 9, 2011 11 :48AM PV21 entry Esti-es No, 2103 1 <br /> ffa�d a- 1 fv 416 2°a Street Phone:(20 9)744-0112 B a <br /> Galt,Ca 95632 Fam:(249)744-0116 <br /> i-t- affords soficotanrmet A PD <br /> Owner Statements of Designated Underground Storage Tank Operator V- 1012 <br /> and Understanding of and Compliance with IUSf Requirexacats <br /> Facility Name: Junction petroleum Inc - Manteca ARCO <br /> Address: 171.1 E Yosemite Manteca CA 45336 <br /> Facility Phone#:209-823-47 7s:Chsnge afDesirerted Operator ��y <br /> [] New Deskusted Operator �►'�- <br /> DESIGN'ATED UST OPERATOR FOR THIS FACILITY: <br /> PRIMARY <br /> Designated Operator's Name: ZANE NIMMO Service Technician <br /> Business Name. AFFORDA TEST [CC#: 5263322-LIC <br /> Dmignatod Operator's Phone. 209-744-0112 Expiration Dau= 3!2212 <br /> ALTERNATEI <br /> Designaund Operarvr's plane: VEIX C� Service Technician <br /> QAAF 1dA TEST ICC#. 52733934-UC <br /> hone: 44-0112 # Expiration Date. 4f7112 <br /> ALTERNATE2 <br /> Dcsiplwod Open �un� %f4 <br /> T ion <br /> Business Name: AZTCTj c#: 5263373-UC <br /> MMI- <br /> Desigrraed Opesador's Phone: 204 7 112 cation Date: -V24112 <br /> .fr <br /> ALTERNATE 3 <br /> Dmivuwd Opuator'9 Namc: LYLE N M 10 ice <br /> HasineGs Name: A2rFORDA TEST [ 7,112 Designated Opef=r%Phone: 209-744-0112 vraDoa Data: <br /> 1 certify that,for the facility indicated at the top of this page,the individuals listed above will serve as Designated UST <br /> Operators. The individuals will couduct and docaunent monthly facility inspections and annual Acility employee training.in <br /> Accordance with California Code of Regulations,title 23,section 2715(c)—(f). <br /> Furthermore,1 understand and am in compliance with the requirements(statutes,regulations,and local <br /> Ordinances) appGcahleto underground sturige tank& <br /> NAME OF TANK OWNER(Print):Junction Pe m—P nl$sins <br /> SIGNATURE OF TANG OWNER: =4 <br /> DATE:8-18-11 O WERS PRONE: '10$-�L 42 --$03 0 <br /> NOTE: <br /> 1) S(MN&T TRIS COMPLETED FORM TO TIIL LOCAU AGENCY('N'OTSWRCB)AFTER S1GMNCj.TLiE LOCAL AGENCY <br /> LIST IS AVATLABLE AT: www.waterboards.ca_sov/usUcormactslcuna AMIjbid. <br /> 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WM TN 30 DAYS OF THE CHANGE. <br /> OFFICE: �- <br /> County: �, r' �) 1 r` �� Ds4c laxed: f / r Date Scanned: `� / <br />