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09/12/2011 14:01 FAX IA0001/0001 <br /> Sep. 9. 2411 11 :48AM C2 Antry Estates No- 2163 P. 1 <br /> ffo rd a-Tet 416 2p°Street Ptwne: x <br /> Galt,Ca 95632 <br /> aQor ftcom-net <br /> Owner Statements of DesigIlated Underground Storage Tank Operator <br /> and Understanding of and-Compliance with USS'Requirements �E� 1 `� <br /> Facility Name: Junction Petroleum Inc-Manteca ARCO � FNj1FA0NMENTAL <br /> Address: 1711 E Yosemite Manteca CA 95336 HEALTH D <br /> Facility Phone#:209-82347 X change ofDesignated operator <br /> ❑ New Deopited operator <br /> DESIGNATED UST OPERATOR FOR THIS FACUffY: <br /> PRIMARY <br /> Deisignated Ope aloes Name: ZANE N1MM0 SemceT'edmidsn <br /> 1Busincss Nznc. AFFORDA TEST ICC#: W3224JC <br /> Desigp aed Operaror's Phone: 209-744-0112 Ekpiration Data 3/7112 <br /> ALTERNATE <br /> Deb,-a aed opmroes Name: FELIX RAl UzEz Seavice Twunieian <br /> Beeriness Name: AFFORDA TEST ICC#: 52733934-UC <br /> Designatcd Opez=t's Phone: 209-744-0112 E)q3irafion Dasa: 417/12 <br /> ALTERNATE2 <br /> Ocs v.a Oparurx`s Mama DAVID WINKLER Savior Tcc]tnician <br /> Business Name: AFFORDATEST TCCt<: SW373-UC <br /> Designated Operator's Phone: 209-744-0112 atpuatiocnDam: 3x4/12 <br /> ALTERNATE3 <br /> Desiguacd Opuzaaes Namc: LYLE N71KMO Savice Tcchnician <br /> Business Name: AFFORDA TEST ICC#: 5249115-UC <br /> Designated Oper�s Phone: 209-744-0112 Dation Date 2/1.4/12 <br /> I certify that,for the facility indicated at the top of this page,the ieuhviduals listed above will serve as Designated UST <br /> Ope nuD m The individuals will conduct and doe mnent monddy facility inspections and annual facility employee training,in <br /> Aerordanoe with California,Code of Regulations,title 23,section 2715(c)—(f). <br /> Furthermore,I understand and am in compliance with the requirements(statutes,regulations,and Focal <br /> Ordinances) applicable to underground storage tanks. <br /> NAME OF TANK OWNER(Print):Junction <br /> P nl Rains <br /> SIGNATUREOF TANK OWNER: <br /> DATE:5-18-11 OWNERS PHONE: '106—v L 42 —?0 J7' d <br /> NOTE: <br /> 1) SUR)vff T141S GOMPI-MM FORM TO THE LOCAL AGENCY(NOT S'WRCB)AFTER SIGNING-THE LOCAL AGENCY <br /> LIST IS AVAILABLE AT: www-wawrboar&.caeovhtst/oantactslaepa am-html- <br /> 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. <br /> OFFICE: <br /> County: c fit'; (na )1 A C��, Date Faxed: C3�,g=IJJ Date Scanned:, 2z��/ <br /> t <br />