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• AGREEMENT BETWEEN UNDERGROUND STORAGE TANK 7WRITTEN PERMIT HOLDER AND UNDERGROUND STORAGE TANK OPERATOR For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited. California Health and Safety Code (HSC) §25284(a)(3); Title 23 California Code of Regulations §2620(b) In cases where the underground storage tank (UST) permit is issued to a person other than the operator of the UST(s), the permit holder must enter into a written agreement with the operator of the UST(s) which requires that the UST operator monitor the UST(s), maintain appropriate records, implement reporting procedures, and otherwise operate as required by the conditions of the permit issued by the local Unified Program Agency (UPA). Use of this form to satisfy this requirement is optional. You may use your own format provided that it satisfies the requirements of HSC §25284(ax3). [Note: "UST Operator" means the person or organization that is in control of, or has responsibility for, day -today operation of the UST system(s), as distinguished from the 'Designated UST Operator" who performs monthly facility inspections and training of facility employees pursuant to 23 CCR §2715.1 A. FACILITY IDENTIFICATION FACILITY NAME CERS ID or Facility ID Tracy Shell 10181411 SITE ADDRESS 3725 N. Tracy Blvd. CITY ZIP CODE Tracy CA 95376 B. UNDERGROUND STORAGE TANK PERMIT HOLDER CERTIFICATION Certification: As the holder of the underground storage tank permit for the facility identified above, I hereby certify that: 1. I am (or represent) the individual, partnership, corporation or LLC, association, trust or government agency that is the holder of the UST permit for this facility, but I do not operate the UST(s). 2. I have provided to the UST operator a copy of the UST permit issued by the local UPA, which is attached to this written agreement and incorporated herein by reference. 3. I have provided to the UST operator a copy of the provisions of California Health and Safety Code Section 25299. 4. I understand that in order to be valid, this agreement must be signed by both the UST owner and the UST operator. 5. I understand that I am required to notify the local UPA of any change in UST operator by electronically submitting updated UST operator information and an uploaded PDF copy of a revised version of this agreement via the California Environmental Reporting System (CERS) website or an equivalent local UPA electronic reporting portal within thirty (30) days of the change in operator. UST PERMIT HOLDER NAME* Anabi Real Estate Dev., LLC NAME OF S NER (print) TITLE OF SIGNER Summer eifej Controller UST HOLDER SIGNATURE DATE SIGNED 1/25/2018 C. UNDERGROUND STORAGE TANK OPERATOR CERTIFICATION Certification: As the operator of the underground storage tank(s) at the facility identified above, I hereby certify that: I . I am (or represent) the individual, partnership, corporation or LLC, association, trust or government agency that is in control of, or has responsibility for, day-to-day operation of the UST(s) at this facility. 2. 1 have received a copy of the UST permit issued by the local UPA, which is attached to this written agreement and incorporated herein by reference. 3. 1 have reviewed the provisions of California Health and Safety Code Section 25299 as detailed on page 2 of this agreement. 4. I understand that in order to be valid, this agreement must be signed by both the UST owner and the UST operator. 5. I understand that by signing this agreement, I become obligated to monitor the UST(s), maintain appropriate records, implement reporting procedures, and otherwise operate as required by the conditions of the permit. UST OPERATOR NAME' RADC ENT RISES INC NAME OF SIG print) Summer Ir ' TITLE OF SIGNER ^ Controller s s UST OP IGNATURE DATE SIGNED 1/25/2018 ,_;, i Z r * Legal name of individual, partners, corporation, LLC, LP, or other entity that is the UST permit holder or UST operator. ENlilrt0�iA47_-_^,A� f, - d i1z, UN -106 wvrw.uoidocs org ra 1 i , r 1/2=tYl/b4/16