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Own.-I Staft-ments of Designated Underground Storage Tank(UST} Opuator <br /> and Understanding of and Compliance with UST Roquircynents <br /> Zoe <br /> FaeflityAddmos; k4 W5 0 C%.C a'Z.a C -,3-e I R=won fbT.3ubmitting this Pion(rherk Ohre) <br /> -- <br /> ChMg*Of DOSIPMCO OPCralOr <br /> —7 <br /> Fzwufty Ph=7: 2-o Q 44:Z � .0-�vz e;-- <br /> eAvernated'UST ODerator(sl for Ws-Facilitv <br /> —PRrUARY <br /> ........................ <br /> MUSinm Name Vf drepentfrom at <br /> 0 0WRI. 0 opentlot C Ewployoe <br /> Wq) 17 44-0 1] Z Service Te*Wdan Tbird-Pwty <br /> laww1and Coda COMOU 6fta-Cation M P*M&M Dow: <br /> ---ALTMWATE I LOggt2eg <br /> Dwou"d opaitur.o No= 7zV'krAf- A- ReMost to UST Fieffity(CAg*(?,1q) <br /> Dwdgum OPM10es?bow it: zos/ <br /> bft"60"I Cod*cow"I Can <br /> ALTERNATRZ <br /> bWPawd 0 NMO: Rqwon ro UST Facility(1.7 a one) <br /> *Ie <br /> (If VWMRI A&M 0&714.), 13 Op=tor Q Ulployee <br /> DIWPACAd opontor'l MOM*- Zo <br /> L <br /> o mrd-purty <br /> Intzmatima C-dz em"il cArtiocation AP <br /> L- i-- — Lragaienticn r? <br /> NOW;T LOCAL RWULATORY AGIONCY MUST IjE NON-XVI ED OF ANY"ANGE-3 TO TMS <br /> INFORMATION WrJ7M 30 DAYS(W TtZ CHANGL <br /> certify that,for the facility iTjdi,;;1(od ut the top of this page,the iadvi&d(s)listed above will <br /> serve as Designated TJSTOPerator(s). The;ndiyidual(,$)will conduct and document monthly <br /> facility inspections and i=aja facility emP]()YeC truftqng,in accordance with'California Code of <br /> Rcgulation%title 23,section 2715(c)-(J). <br /> Furthermore,I UndersUnd.and urn in compjiunce with the requireinenis (Statutes' <br /> MEIW1049,and IocW ordinances) g1pplieubje to und*r-r(mild gtonge uu)jks. <br /> NAME 0IP'rANK OWNER(Pleau Print).-_CcC n e <br /> '51GN ,TURK 0PTA.NjK0wNrLjZ- <br /> DA*rr,.. OWNSWS PUONE th <br /> logo <br />