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12/13/2004 23:00 5308887351 <br />2 <br />NELLA OIL ANNEX PAGE 02 <br />San Joaquin County DEC 16 2004 <br />Environmental Health Department <br />304 & Weber AM, Third Floor Stwktov CA "202 <br />Tdeplione (209) 46$-347,0 Fax (2 09) 46FI-3433 <br />P <br />0�vner Statements of Desipated Underground Stomge Tank (UST) 0PCMt0r <br />and understanding of and Compliance with UST Requirements <br />SIT <br />; <br />�'01 , <br />=4= 1 <br />0-1 <br />077,77,777 Iter—T-ITUO., =71, WT-M.-M—M-71 MOMM, <br />3C."22P-01 <br />,AAMV a <br />Tot Lk -TIM I <br />W.1 14 A JUA <br />#MT <br />P110' ' =Jk <br />NOTE: THE LOCAL REGULATORY AGXN" MUST BE NOT1FMD OF ANY CHANGES TO THIS <br />INPORMATION WITHIN 30 DAYS OF THE CIMOGE. <br />Forthcrinore, I understand and am in compliance with the requirements (statutes, <br />reguladous, and local ordinances) applicable to underground storage tanks. <br />NAME OF TANK OWNER Mme Pdut)-. <br />SIGNA rURE OF TANK OWNER. <br />DATEs /,) -, / - C> V <br />M <br />L <br />M <br />