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Successor-In-Interest Designation Form To: ARCO Products Company, a division of Atlantic Richfield Company("Franchisor') Re: Facility No. 6020 Gary L. Burgin ("Franchisee") (Franchisee's Name as it appears on Franchisee's Agreements with Franchisor) 1711 E. Yosemite (Address) Manteca, California 95336 (City, State, Zip Code) In accordance with the provisions relating to Successor-in-Interest set forth in, as applicable, my current PMPA Franchise Agreement/Premises Lease/Dealer Lease/Contract�Dealer Gasoline Agreement and/or am/pm Mini Market Agreement and/or MP&G Tune-Up enter Agreement [Agreement(s)], I, as Franchisee, designate the primary and, if indicated, alternate Successor-In- Interest named below. I understand that my spouse must execute this form in the space below. If someone other than my spouse is designated as my primary or alternate Successor-In-Interest. This designation shall supersede all prior designations made by Franchisee relating to Successor- In-Interest. Primary Successor-In-Interest Alternate Successor-In-Interest (Full Name) (Full Name) (Address) (Address) el ?U(/c 1-v1✓ CP r1S C!1N G C, (City,State,Zip Code (City,State,Zip Code) N)k C I-(-r--K. (Relationship to Franchisee:Spouse,Adult Child, Relationship to Franchisee:Spouse,Adult Child, Parent, Partner or Corporate Shareholder) Parent, Partner or Corporate Shareholder) Gary L. Burgin Franchisee's Name as it appears on the Agreement(s) WITNESS (Signature) (Date) (Si ur (Date) (Title,if Corporate Franchisee) I, the undersigned, am the spouse of the above-mentioned Franchisee and I hereby acknowledge that I understand and agree to the primary and alternate Successor-In-Interest designations made by my spouse and I hereby waive any claim of interest in the franchise or franchise agreement for the ARCO facility named above. Signature: Print Name: Date: