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02/27/2009 16:32 FAX 17074466192 <br />TANK-TEK la 004/004 <br />1 - 1U/ 6.6 <br />UNDERGROU"STORAGETAN K SYSTEM <br />E <br />- T docs F®SIGNA UST OPERATOR AND <br />aMPL�C WITH UST REQUIREMENTS S <br />rusebyJnl <br />Member Agencies ur where approved by your Local Jurisdiction <br />A, fM9 Tdtle 23, Div. 3, Ch. 16 California Code of Regutdtlom (CCI) <br />JOA00N COUNTY <br />FACILITYSITP . D... DEPARTMENT <br />3202 W, HAMMERUN"E <br />Vj t1 III . a <br />D"JONATED TORNAW: Virginia FUlgaro <br />KM AT10N TO UST FACILITY (CheckOPA) <br />❑ owner ❑ operator ❑ rmployee <br />❑ S®rulcm'1'ocpnfclsn 'Jriird-Parry <br />BUSINessNAII Evidobrearfrosabow): Tank -Tek En-vironmenbil Corp. <br />DFSIONATMOPERATORPHONE: (707) "11-6151 ext. <br />NTERNATWNAL CO,OI3 tAUNCII, CFR'I')PICA-nO'N WO.: 6322644 -UC <br />EXPIRATION OATP: 11/17/2009 <br />ORSIGNA-PM OPHRATOK NAM 9=110118®1(fiAlks) Lawrence <br />RM A710M TO UST FACILITY (Check Ow) <br />❑ owner Q OT"Mr ❑ nmplayee <br />® ScMcc Technician ❑ Third -Party <br />DUS1NESS NAME (d'dWerent from above): Tank -Tek Environmental Corp. <br />DlsSIGNATED OPF.RA'rOR PHONF: (707) -6151 ext. <br />INTERNATIONAL. COUr•. COUNCIL C'ERTIFICATIO'N NO.: 10"1103 -UC <br />MGMATION DATE: 1011-2/2009 <br />jasigTOPERATCi1 : I i , ,, <br />DESIONATED OPMtATOR NAME; <br />RELATION TO UST FACILITY (Ch.ek Orw) <br />❑ Owner ❑ Operator ❑ Fmploy e <br />❑ Servla Technician ❑ Thud -Party <br />BUSIN,M NAMR (4Vd0mwA= above); � <br />D28I04ATBD OPERATOR PHONE, ext, <br />ATIONALCODBCOUNCIL CERT11;ICATION NO.: <br />aXPIRATIONDATS: <br />iII[+i1Qit]lFYli <br />❑Owner ❑ OperWor ❑ Employee <br />❑ Servica9'echniclan ❑ '"t'hlyd-party' <br />I certify that, for the facility indicated at the top of this page, the ludividua l(s) listed above will serve as Designated UST <br />Operator(&). Tiro Individual(t) will conduct and document monthly Pacllity illspections and annual fscllity employee tMinitlg <br />in accordance with California Code of 12ogulationz,, Title 23, Section 2715(c) through (t). Furthermore, I understand and am <br />In compliance with the requirements ((stn %emulations, and local ordinanee&) applicable to underground storage. tanks - <br />TANK OWNER NAME: U6 <br />TANK OWNER TITLE: �l J7Ct? r f OWNERI'1g0N13: <br />TANK OVIM SIONATURE: DATE: <br />x1�� 6 RiiAr1 •�e, 7 <br />1. Report ft name(s) of the Desipmed UST Operator(s) as rc&lcred with the International Code Council (ICC)- ICC e®Rificasion <br />information is available on-line at .kcsafO org/c/co rch.htmL Search for "California UST System operators," <br />2. Submit this comp to the local agency that ra9gulaws this fwAilty's USTs. Unidocs member agency jurisdictions and <br />contact ,information we listed on -lino aC www.unldoe. memberslwh"ubteswhaLhtnd, Contac Information for other <br />local opmdes within California is available at: www.swrob.co.pylewphome/nitteoniacts/does4oim]_WncyjisLxls. <br />3. 23 CCR 12715(x) trquires that you notify the local agency of any changes to this information within 30 days of thea date of chango. <br />UN -062 -1/1 www.unklomorg <br />