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0 0 <br /> Owner Statements of Designated Underground Storage Tank (UST) Operator <br /> and Understanding of Compliance with UST Requirements <br /> Designated UST Onerator(s) for this Facility <br /> Facility Name: , ` Facility ID#: <br /> Reason for Submitting this Form(Check One) <br /> Facility Address:/o 9 7 <br /> ESG.f laid/ ❑ Change of Designated Operator <br /> Facility Phone ❑ Update Certificate Expiration Date <br /> PRIMARY <br /> Designated Operator's Name:LYLE MEEKS Relation to UST Facility(Check One) <br /> Business Name(IfdI ferentfrom above):Franzen-Hill Inc. ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:(559)688-2977 % Service Technician X Third-Party <br /> International Code Council Certification#:8188753 Expiration Date:01/18/2015 <br /> ALTERNATE 1 <br /> Designated Operator's Name:RON ROCHA Relation to UST Facility(Check One) <br /> Business Name(If dierentfrom above).FranzenHall ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:(559)688-2977 xSevice Technician XThitd-Party <br /> International Code Council Certification#:08193095 Expiration Date:6-7-15 <br /> ALTERNATE 2 (Opdono <br /> Designated Operator's NameAdam Taylor Relation to UST Facility(Check One) <br /> Business Name(If di,(ferent from above):Franzen-Hall ❑ Owner ❑ Operator ❑ Employee <br /> Desi is Phone#:(559)688-2977 xService Technician x -Party <br /> International Code Council Certification#:8143455 Expiration Date: 1-2-15 <br /> I certify that, for the facility indicated at the top of this page,the individual(s)listed above will <br /> serve as Designated UST Operator(s). The individual(s)will conduct and document monthly <br /> facility inspections and annual facility employee training, in accordance with California Code of <br /> Regulations,title 23, section 2715(c)-(f). <br /> Furthermore,I understand and am in compliance with the requirements(statutes, <br /> regulations, and local ordinances)applicable t under/ground storage/Ranks. <br /> NAME OF TANK OWNER(Please <br /> SIGNATURE OF TANK OWNER.- <br /> DATE: <br /> WNER:DATE: / �' ` / OWNER'S PHONE#: <br /> ECEIVEn <br /> 014 <br /> NOTE:1)SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY(NOTSTATE WATER <br /> RESOURCES CONTROL BOARD)BY JANUARY 1,2005.THE LOCAL AGE I <br /> AT:www.waterboards.ca goy/istipontacts/cupa agys.html. NEAT- T T <br /> 2)NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS <br /> OF THE CHANGE.\ <br />