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Jan 23 12 06:20p AFFORDATEST 20 44-0116 p.1 <br /> Jan 23 12 06:00p AFFORDA TEST 209.744.-0116 P. <br /> Afforda—Te 416 2nd Street Pttoue:(2D9)744-(1112 <br /> Gait,.Ca 95632 :Fart: (-�0R)744-0X16 <br /> mitords •ufGcon7.ttet <br /> Owner Statements of Designated Underground Storage Tank Operator <br /> and 'Understanding of and Compliance with LUST Requirements <br /> j Facility Nalnoiet � <br /> Facility#- <br /> Address: ( 'N'+ �® 1 CY,-f7 <br /> F�aasiltty Phone fr`:. Lj Ch4ncrof Dnignaicd Op rotor <br /> Q Now Desli�ared gparater, <br /> :,. 4"-. ld <br /> DIE r i rMU VST OFERA'. oR FOR TIM FAMATY <br /> PRTMARY <br /> Desig.ated0parator'SNarne: ZANENINIMO Sravitcrcchnician <br /> hluinvu Nana: AB 4001RIPA <br /> l signeced Operames Pba=.. 209-744-0112 „`A =r ' piralion ria1a: a12t1_ <br /> AL'I`>rTdNA'I`E 1 <br /> D�-9igr�[ed f}neratnr'c N�,rc' F�..Y7C RAMF Savi�m Tee>>�tivtxt <br /> Dus;r•ca,Na= AJ+FORDATES"f IVtI"s3iVdlE, d���>» ICCiF: 53 3954-LC <br /> Di igrtetetlOp=tor':;PFane: 204-744-0ti2i� 1LTfE -EEAPTtjp�I7-:IN d" D%pirationDato: 417:12 <br /> ALTERNATE Z <br /> Desi;Pttnad lovwwo:'s Nw.;: J?"ID WINKLER Scr%ieo TtWinieinn <br /> ausin:ss Name: A."ORITA TEYT ICC k: 5263373-UC <br /> ncsigtatod Operawes'pb alas 234-744-0112 Expiratiop Data: 124122 <br /> ALTERNAM 3 <br /> Designate„Operator's Manx:: LYLE NJ1YJX0 Somite Tecimicrta <br /> Oesi uss Nu nc AFFORD.4 TEST ICC 9: 22491.15-VC <br /> I7esD;{Q1Cd Qperator's FltoDte: 2(}9-7dd_C)t 13 <br /> Expiration DatC: .d2art;�' <br /> I ccrraty that,:br tbo fadlity indicated at the'or ott.his pale,chi individtaa.ts 11'54TCd 2hnvr.Vrill serest;us 13oeigngtcd UST <br /> operators, rhe individuals ai.11 conduct a,:d cocumern monthly facility itaspectlons and annual:3toility employee training, in <br /> Aocordanca with Ca:ifomia Code ofReplationS,litic 23,sMior.27 15(c)—(0. <br /> Fut•thur,nure,T undderatadd aari am in com.ptistnce with the requirements Istatu;ts,regulations.and toefll <br /> Ordinances) tipplieablc ce underground sta,tagetanks. <br /> NAME OF TANK OWNER(Prinr). <br /> S;IGNA'PZIRIP,OF TANK OWNER: <br /> DATE: O�'1`1lIJRS 1P Z4N'E: .�" <br /> iVO7E: <br /> I) 3unMlT THIS CiMrI.E rt n irO1t M'TO THE LOCAL AGE14CY C`IOT SVca)A R SiGAtIJ:G.THG LOC.g1 a U`L`ttiC1' <br /> LIST IS AVAILABLE AT: _wmW wnt ttnierr?a.^ <br /> DI�Fte^ 2) NOTI PY 7.41S LOCAL AGENCY OF ANY C1,ItANGES TO TIgJS 1NFORMtATiON WITHIN 30 DAYS 0P'CE{E C:-IAMF <br /> County:- ',1b '�c w� bate Foxed: ate Scanned; <br /> 4 <br /> TO 35)Vd 3AZtOSAIMA Z90ZZE860Z ZT:90 ZTMz/EZ/T0 <br />