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.May 04 11 03:10p Reliable PetroleumA 209-845-8953 p.14 b Owner S ements of Designated Underground Storage Tank (UST)"fqaor an Understanding of and Compliance With UST Requirements 0, l Facility Name:SB S&141A.RT Facility ID#: Facility Address: 51 W 11a'Street,Tracy CA 93376 Reason for Submitting this Form{Check Dne) Change of Designated Operator Facility Phone : 209-834-48&38 X Update Certificate Expiration Date Designated UST Olnerator(s}for ilk; Facility PRIMARY Designated Operator' Name: Robert Barnhart Relation to UST Facility(Check One) Business Name(Ifdi rent from above):Reliable Petroleum Senices Inc. Q Owner � Operator C Employee Designated Operator' Phone 9: 209-604-9336 X Service Technician ❑ Third-Party International Code C ncil Certification#: 5252540-UC i Expiration Date: 12-23-2011 ALTERNATE I t? oxal Designated Operator' Name:Guadalupe Sanchez Relation to UST Facility(Check One ) Business Name(If dl rent from above):Reliable Petroleum Services Inc. ❑ Owner ❑ Operator ❑ Errtployee Designated Operator' hone#:209-604-93633 X Service Te clinician ❑ Third-Party International Code Co nciI Certification#:5250451-UC Expiration Date:01-29-2013 ALTERNATE 2 (op &ad) Designated Operator's game: Relation to UST Facility(Check One) Busincss Name (If r ent from above): O Owner ❑ Operator ❑ Employee Designated Operator's bone 4- ❑ Service Technician ❑ Third-party International Code Co cil Certification#: Expiration Date: I certify that, for a facility indicated at the top of this page,the individual(s) listed above Will ^Y serve as Designal i d UST Operator(s). The individual(s)will conduct and AoCuMent monthly facility inspectio and annual facility employee training, in adcvrdance-With California Code of Regulations,title 3, section 2715(-)-(fl. Furthermore,I i nderstand and am in compliance with the requirements (statutes, regulations,and Desi ordinances) appl' ble to underground storage tanks. NAME OF TANK OWNER(Please P ' t `z-,7- E j/ f SIGNATURE OFT NK OWNER; L DATE- 0�i7 A1 OWNER'S PHONE NOTE: E)SUBMIT HES COMPLETED FORM TO THE LOCAL AGENCY(NOT THE STATE WATER RESOURCES CON ROL BOARD)BY JANUARY 1,2005.THE LOCAL AGENCY LEST(S AVAILABLE AT: lt�+:'4 :t��\•:.:•atc 2)NOTIFY THE LO CAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE.