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Of <br /> r <br /> Owner Statements of Designated Underground Storage Tank (UST) Operator <br /> and Understanding of Compliance with UST Requirements <br /> Facility Name:BP Site 6080 Facility ID#:6080 <br /> Facility Address: 85 E LOUISE AVENUE Reason for Submitting this Form(Check One) <br /> LATHROP,CA X Change of Designated Operator <br /> Facility Phone#:209-983-9144 ❑ Update Certificate Expiration Date <br /> Designated UST Operator(s) for this Facility <br /> PRIMARY <br /> Designated Operator's Name:Tony Duncan Relation to UST Facility(Check One) <br /> Business Name(If different from above):Delta Environmental Consultants ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:916-475-4270 ❑ Service Technician X Third-Party <br /> International Code Council Certification#: 5246340-UC Expiration Date: 11/6/2006 <br /> ALTERNATE 1(Optional) <br /> Designated Operator's Name:refer to backup document Relation to UST Facility(Check One) <br /> Business Name(If different from above):Delta Environmental Consultants ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:refer to backup document ❑ Service Technician X Third-Party <br /> International Code Council Certification#:refer to backup document Expiration Date:refer to backup document <br /> ALTERNATE 2 (Optional) <br /> Designated Operator's Name:refer to backup document Relation to U�Facility(Check One) <br /> Business Name(If dierent from above):Delta Environmental Consultants ❑ Owner Operator ❑ Employee <br /> Designated Operator's Phone#:refer to backup document ❑ Service Technician X Third-Party <br /> International Code Council Certification M refer to backup document Expiration Date:refer to backup document <br /> I certify that, for the facility indicated at the top of this page, the individual(s) listed above will <br /> serve as Designated UST Operator(s). The individual(s)will conduct and document monthly <br /> facility inspections and annual facility employee training, in accordance with California Code of <br /> Regulations, title 23, section 2715(c) - (f). <br /> Name of tank Owner(print): Chris Moul <br /> Signature of Tank Owner: '71_1__^-_____ <br /> Date: 6/l/06 Owner's Phone 4 (714) 690-2349 <br /> In December 2004, BP West Coast Products, LLC submitted a separate letter to the local <br /> agencies documenting compliance with UST regulations. A copy of this letter can be made <br /> available upon request. <br /> November 2004 <br />