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San Joaquin County <br />Environmental Health Department <br />600 E. Main Street Stockton CA 95202 <br />Telephone (209) 46"420 Fax (209) 468-3433 <br />4wner Statements of Designated Underground Storage Tank (UST) 0pemt0T <br />and Understanding of and Compliance with UST Requirements, I <br />grim <br />MV I <br />ON oil <br />ffrm.M&�� <br />IPIDIMA12V <br />Rclation to UST Facility (Chea Om) <br />ALTERNATE 2 (00donat) <br />M <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 conductoW document monthly <br />facility inspections and annual facility employee training, in accordance with California Code of <br />Regulations, title 23, section <br />SIGNATURE OF TANK OWNEP <br />DATE: OwNEWS PHONE M_1 <br />