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07/08/2014 12:27 2094732344 MARCH LANE 76 PACE 01/01 <br /> RECEIVED,joe <br /> �{UST} <br /> Owner Statements of Designaed Undergroundtorae Tan OPerator <br /> and Understanding of and COMPliance with U Rft"WiMM HEALTH <br /> Facility Name, Unocal DEPARTMENT <br /> FacilftY Address: 2701 March Ln. N10111ty 11)9; 256886 <br /> Stockton, CA 95219 Reason for Submitting WA Form <br /> Faclttty Phone: (209)473-7337 M Change of Designated Operator <br /> oesignaEed 13 y <br /> eCertiflmte EVIration Date <br /> Primary20 1OPemtor(s)for this 7 ij; <br /> 00304ted Operatoes Name; Marie Guarneiv Re <br /> Business Name(ffdyfferant FAX"above): <br /> Designated OPeraWrs Phone*.- . Service station s terns 0 Owrw 0 Operator 13 Employee <br /> 408 971-2445 <br /> lnter»ational Code Council Cartircation g: <br /> 8168671-UC 11 SerServicev' Technician a Third-Party <br /> ------------ <br /> Expiration Date: 4/17116 <br /> Alternate I(QPhlonal) <br /> Designated Operator's Name- Kris Bell <br /> Business Name(if ' Mom at,")., Relation to LISTFacilityctmrt on,,) <br /> O"naw Operators Phone 0. SeM ce�StstiOn S Stems 13 Owner a operator 0 Employee <br /> Intemeianal unell Cert'S <br /> Cme 408)971-2445 M Sor"iCO Technician ig Thfrd-party <br /> "ll'On 0: 5297793-UC MWIratron DPW <br /> Attemate 2(optional) <br /> 12/2115 <br /> E)esignlskev Operator's Name: Dave Thomas <br /> 80stness Name rff different From alcove <br /> Relation to UST FacllltyQ�ea One) <br /> Signaled Operajoels-"Ore bo"k Service S Von Systems 0 0"'ner 13 OPeratOf 0 Employee <br /> 971-2445 3 Service rethnician 3 Thira-perty <br /> International cma On#,' 8201084.(JC <br /> Expiration Oats: 612116 <br /> Tank Oarner <br /> Certify that, for the facility indicated at the top Of this page• the individual(s) listed above will Serve as Designated <br /> UST Operator(s). The individual(s) will conduct and document mOnhY facility inspectionannual facility <br /> $and <br /> emPlOYee training, in accordance with California Code of regulations, title 23, Section 2715c - <br /> FUrtherr"ore, I understand and am in compliance with the requ'rements N ( ) (0. <br /> (statutes, regulations, and local applicable to underground storage tanks. <br /> Name Of tank owner(pleas P 'nt): <br /> Signature Oft k ner: <br /> oats: Owner's Phone#: 620 <br /> 1)Submit this camps OW form to the Local Agency(NOT the State Wate <br /> r <br /> Resources control (Board) <br /> By January 1,2005.The local agency list Is available at: www.waterb <br /> 2)Notify the Lova!Agency of oards.ca.gmlustioonte=/cupa_agyg.htmi� <br /> arty changes to this information within 30 Dap of the change. <br />