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LD�AGp FAX 1,10. : 4786342 .Jul. 23 2008 12:OOPM F'1 <br /> Fg ,r •:x.& R"I v v t <br /> E 200 <br /> SAN Jo t en's of e:'"t9natetd U rider Dromid torage'Tank Operator <br /> SANE JO I N NTA J�Und�Q"S i9�1 (D c`Ilid {. 1;# with UST L dre e�t3 <br /> HEALTH DEPARTivc..: N <br /> OLA <br /> pFaCiOtY <br /> My NaaMe: a <br /> Y i I�wa.3cra roc taus farm; <br /> 0,.' r F ® Change 01,Dcsi�►ted 0 erator <br /> Y. <br /> Pb;w#; <br /> tjpdate�'ciyilicate i'xpiraaion D3stc <br /> e <br /> I)ESICNATED U T OP '[' R F C11RTizl15- FACILI'TV! <br /> PRIMARY <br /> Service Tcclanici�ra <br /> txsignatted Operator's Name: F YLII:D.N1(MM0 <br /> I3uisies5 Nana: <br /> At''l':4RDA-Tr,$T It't;1t <br /> Demignale'd Optfator°s Phone ff: 209744-0112 <br /> F,xpitizti <br /> 7?Di2t3C►�) <br /> otiL7atc: <br /> ALTARN,(TE I <br /> T)e ciacatcd Uperetur's Naeme <br /> RlAVID A.WINKI� FIi Scsrvice'I'coht)ici�an <br /> L3t:5inc55 tJamk.� <br /> AF,0Rl)A-TEST' 52(13373-i1C. <br /> lleaa ted Oaesator%Y110rLe 9'. <br /> ?t39 744-U l! , 3 271 t}10 <br /> AJLTEJUNATE 2 <br /> maipplastud r4iva''INmne. "Zk-iF+, A. 1VtDVIDV O ticrviceTeoha)ioiati <br /> > 'QusincssNamc: <br /> AF''h'ORDA-TEC N' tt C'fl S2C333 -1)C. <br /> Msip atcd t�pb r;atar',l'hoatc t#- tut)744-1,112 Lixpirsauuu C.)att: 3/14J2010 <br /> ALTERNATE 3 <br /> ated Operatnr'rt ititc': <br /> FELIX(=liiAi�fi4 >tJl Service Technician <br /> [3trtirtess S?734s$-t Na, <br /> tot F()Kl�h-T t [CC: JC> <br /> ih�ibnatcd Vp-t'at0t''s Ph<sx►e#: 2t?97.a•4-t31 I <br /> Fix imtion Date: 6/7 l(2Cs1(} <br /> 1 c reify th�xt,Our rho f oiliiy indic:eted mt the tap C11'01is page.tile:iitciivi+iusfs iNted above will SeRIC n D)cs gnaNd I IS'D' <br /> C}peraturs. The individual',will"induct wid doc umrnt rrintith(y facility in4peci.it�tts�9ttd anzaual tae itit�e�pFcsyee truizli��,in <br /> accordance with Cali€omia C:odc of RcgtL1ati0nS,title:23,s"tion 2715(c)-(F!. <br /> Fortberrnorv7 l understand and un+ In Gnrni)Fiar►ce wttn the requirvawnts (mitatutos, re uladons, and local <br /> ordinances) al)drlivable to underground storage t>tnita. <br /> NAME OF TANK OWNER (Print)'.4 <br /> SIGNATURE OF TANK OWNER! . � 4 0fly OWN,ER,5 P14ONF: <br /> ----- <br /> VATE; �- <br /> T OTT: IFT PSt AMYI1Ds t'8'DI'ORM,FOT54E LOC.Al,A.GF[vt.Y(No Tgl'A'c -WAT R (t SCO a OARD) <br /> &l:'1j8m1dC,�NIiMICi.THD G+LI(;ALAGENt:y1JS'T t;%AVAI �Al�ll EAP ,wwu. a cl gvfustltxtn" <br /> 2)N(.)'I'IFY'f)IE A3.AC.EN(:-V()FANYCHANCst,.S`lt3TH);I-t FCJrKta ATIONW IN30DA1'SQErIllFCHANt.E. <br />