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12/10/2010 16:37 FAX lAt)002/0004 <br />:I <br />It 416 2n' street Phane: (209) m 2 DEC 1 0 2010 <br />`aifa <br />G04 CR 95632 Fax: (209) 744-0116 <br />aloftcom.netSANJID <br />Owner Statements of Designated Underground Storage Tank Operator � 3 <br />and Understanding of and Compliance With UST Requirements F 9; <br />Factiiit'� ante: Rai - GQ -71, Facility <br />Address: 1� 40 E M�% mi �--e. ! v ±voxel c... cr-, a53�tc, <br />FoLeft Phone #: Zoel ❑ C6aal c of Designated Operator <br />XX9C ewbesionated operator <br />&E -S1 1NA ED UST C}P TOR Ft1It THIS Ft#CILITX• <br />PRIMARY <br />Dt aignatsd O 's NIMW. ZANE NINN,IO Service Technician <br />Business AFFORDA TEST ICC 4: =63322, UC <br />D%i$natcd OPenitOes Phooc: M-744-0112 Expiration Darr 312!12 <br />ALTERNATE i <br />OnigtaW Operator's Nath FEUX RAMIREZ <br />Businmq Name AFTORDA TEST <br />1D"S'Pated Operator's Ahattc: 209-744-0112 <br />rc•. DAVIDVVTNKLLR <br />Dwignatcd Opetatoes Phone: <br />209-744-0112 <br />ALTERNATE 3 <br />Desisnssed Operator's Name: LYLE NIMM® <br />Designated OpcmWr's Mm. <br />209-744.0] n <br />Service Technician <br />TCC #: 527339344JC <br />Expiration Datm 4/7/12 <br />Service Tedwiciaa <br />ICC #: 5263373 -UC <br />ExpiM60n Daft: 3/24/12 <br />Service Technician <br />ICC A: $249115 -UC <br />exPimnon Date: 2124/12 <br />I certify that, for the facility indicated at t52e top of this gang the individuals listed above will Serve as Designated UST <br />Operators, The individuals will conduct and document monthly facility inepc ctions and annual facility employee training in <br />A.ccordarxx with California Code of Regulations. Citic 23, section 2715 (c)— (fl. <br />Furthermore, I understand and am in compliance wie the requirements (-at$tutes, regttlatsOes, an8 focal <br />Ordinances) applicable to underground storage tanks. <br />NAME OF TANK OWNER (Print): � ' t•' a, <br />S14GNAT JRE OF TANK OWNER: f% • <br />DATE:11/1/10 <br />1�t iz o <br />NOTE: OTE: OWNERS PRONE: &1.9 1,0 <br />1) SUBMIT THIS CompLETet7 FORM TO THE LOCAL AGENCY (NOT SWRCB) AFTER SIGTTII�G. ]FTE LOCAL AGENCY <br />LIST IS AVAiLARLS AT: �hv r c a h <br />2) NOTIFY Tka LOCAL AGENCY• Op ANY CHANGP_S To THIS INI:ORMATTON WtTHiN 30 DAYS OF THE CHANG& <br />OFFiC,P:• <br />County: r1 Lt1 !Date Faxed:�„_Dste Scanned' - /ate <br />