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,*u1 20. 2007• 8: 34AM West Star E n v i ronmenta1, Inc. No. 3397 P. 2 <br /> iu I. 17. 2007 3: 08FM0 <br /> est .t,ar Env ironmenia;. Inc. ` ti,;. 3214 P. 2.1 <br /> C)wn.er Stwtements of.[designated Underground Storage Tan'K(UST) Operator <br /> and Understanding of and Compliance with UST Requirements <br /> Facility�I:eme: j r�LQL;Yti i Faeiliry IU _ <br /> racility Adsitess: l4� Z O �titi L. Reason for Suhmittilrg this Form(G'lu+ckOnc) <br /> Ch:u►ge or Designated Operator <br /> Fatality Phone#: C� �3j �� b <br /> R updva Certificate P1:piratiou Dare <br /> DesigL3ated ITST t7 erato s for this Facili <br /> PRIMARY <br /> migrated Operaiur'-s Nam: Nick Adairitz Relation to LIST' <br /> C Facility((..heck Ong) <br /> BusiE nese Naftic(if ca erpi from above): West V4rEAvir0nmenta& {nc !IL'3 owner a operator 0 Empttyce <br /> i)osigltatcd Operat-or°r phdnc#: 559-277.9378 x010 � <br /> SpviccTechniciar► ❑ 'l'hird-Party <br /> Intecnaricutal Code Councit Certification it: 5�aii325 _ � 6xpstai!a�date: 1 kisviuii � <br /> ALTERNATE 1 <br /> Dosignated Operatar's-Name: Jason rsgatda ?(?.el ►Ato 11 SIT aciiily,.(�Claeek ) <br /> Bttsincss Name(Ijd Arent from,above): #: N%st Star Einirunnsenta1 Inr. 6, owiwl C 41le=or-•-L3., emplayz: 1 <br /> - ,--�r�t'vtit�7$s5rifcian-"❑�►cdrl��'tr y,✓"f <br /> Desipmted Operruor s Phonc#: fi: 559-277378 x31)10 - <br /> Internatinrzal G>de Cvunci!Cettific tion 52137314 E,piration Date: 1/25/09 _ <br /> ALX ERNATE 2 (Opddhai) <br /> 17eg1 nsted Operator's Name: Billy 13owdan w , Ro atiun to LIST Facility(Check One) <br /> Business Nam((!f drferent from above). Wes!Star 1::tvironmaita4 Inc ❑ Owner 0 Pperator Ci ?"MPI <br /> Desitt►tted 0� Ptor`s Phan(#:539-277-9375 x3015) Service'i'echnician © Third-Petty <br /> lntcrnatinnal Cedc Council(;ertifrcFttiort : 5305229 rxpirationoute. ?120/09 <br /> 1 certify that,for the facility indicated at the top()f this page,the individual(s) listed above will <br /> serve as Designated UST operator(s)- The iadividtuai(s)will-conduct and document monthly <br /> facility in.SNCs ons and annual facility employee training,in accordance with California Code of <br /> k Regulations,title:23,section 2715(c)-(f). <br /> Furthermore,T understand and am in compliance With the requirements(statutes, <br /> i <br /> regulations,and local ordinances)nppHeablc to underground storage tanks. <br /> NAMEOF TANK OWN (Ylea�QXl►rt);��rl U J� � /v <br /> OWNER <br /> SICNATURE OF TANK OWNER; <br /> DATE: — UOWNFRIS PHONE -- <br /> NOTE: 1)SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY(NOT THE STATE WATER <br /> gESOURCES CONTROL BOARD)OV JANUARY 1,2006-TRE 'LOCAL AGENCY LIST 1S AVAILABLE <br /> AT:www.wtcrbo3rds.caavfitst'cootets/cun� s - <br /> 2)NOTIFY THE LOCAL ACENC'Y OF ANY CI4ANGFS TO THIS INFORMATION WrMIN 30(DAYS <br /> OF TEJE CHANGF <br /> Novemher 2004 <br />