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04/13/2009 15:24 FAX 17074466192 <br />TANK-TEK <br />0 <br />UNDEI2GROOND STOPLNGE TANK SYSTEM <br />OWN1~ R STATEMENTS OF DESIGNATED UST OPERATOR AND <br />UNDERSTANDING OF AND COINIPLIANCE WITH !IST REQU1REMI UNITS <br />For ure by Unrdocr Aiember lgencees or there approved 4c your Lucul JurIsdictron <br />4vdror ly t'ile& Tide ?3. Div, 3- Ch• 14 Colilbrnia Code of Regida Toru (CCR) <br />IA002/004 <br />FACR_iT1 NAME {FACILITY PHONE <br />CRLLC #270"" I 209443-2082 <br />FACIL1rY SRI% ACsDWSS erre• <br />1403 COUNTRY CLUB BLVD STOCKTON <br />REASOi4 FOR SUB%LMrM THIS FOIV !Ch cd Gere!. Upd4r of ICC Certiliwlton Expiruian Ume(s) <br />PuttwA0V 1!C_C1V-N&TCl117.CTnPV0ATnt2 FAR THTC I:ArTI-MV <br />DE MMATEDOPWAT M NAME* Daniel Lawrence <br />j RELATION 1.O Use FACIMY ICArgk tom.) <br />❑ Owncr ❑ ()P. -w ❑ Elnp)o)ce <br />❑ ScrviccTcchnician ® Third -Party <br />BUSDUSNAME (11gW—fimabn=)= Tattle Tek Environmental Corp. <br />DIa5 xAT'FDOP£RATokPHoNR (707)44$4151 exL <br />rN i7iwA1VS1AL CODE COUNCIL CERTIFICATION NO.. 8025453 -UC <br />I & XPIH 1 VN DA ri 3/14/2011 <br />AL r't-UMATE 1 DIESI'GNATMI UST APERAMR MA TI4111 FAC)Lnl'i' 18nririanll <br />DiNIONATFDOMATORNAMP-- Richard Thomas <br />RE:%TIOY TO UST FACIL "WArair Omi <br />i ❑ Oumer ❑ opermor ❑ Employee <br />El �� %cjnticCBu ®T1�ca r�ty <br />' <br />9ErSa>�Ssi�Alr�e(!d(�errrrrhona6weJ: Yank Tek Environmental Corp. <br />DFswKATEDOPEPA-m rn w\s (707)446-J451 ext <br />WMRNAnONAL CODE COUNCIL CERTIP1CAMN NO,: 5254736 -UC <br />9XPIRAMN DAM 1/2012011 <br />ALT£RNATb 2 IMIGNAT$D <br />DESIGNATED OPERATOR NAM L' <br />Lawrence <br />B MEM NAME (00-wIPpun bowl. Tank Tek Environmental Corp. <br />1DBIONATED01MRATORPMNE: (707) 446-6151 OXT. <br />rNTMAMONAL CODE COUNICI CE"IFICAT ION NO.: 1048103 -UC <br />ALTZRN'ATE 3 DESIGNATED UST OPERATOR FOR THIS FAOLM <br />nf1GYAT1-D OPEmTOR riaWE: Virginia Ful®aro <br />Is1NEss NxmF (1fdVk&-1.n=alb►,), 'rank --Tek Environmental Corp. <br />RPLAfION Tu L;S'r FACIU Y iChceko„rJ <br />l <br />[3 Uwnar ❑ Operator [] Employm <br />❑ Seniec Technician 12 Third -party <br />E%PrKAT *%- DATE 10/12/7009 <br />RELATION TO UST FACiLrry If rk (h,•1 <br />I❑ C)WPCT ❑ Opentor Cl cmPlo."W <br />❑ SCrvicc Tcchnicron ® -lbird•l'any <br />! INTLKNAriONALGOOD64Mt,NCILChRnV)CAT70NNC- 53226"UC i FXPIRATIANDATE; 11/17/2009 1 <br />I certify that, for the facility indicated at the toll of this page, the individual(s) listed above will serve as Designated UST <br />Operator(4 The individuals) will conduct and docament monthly faeillty inspections and annual facility employee traiiuiag <br />ire accordance wild! California code of Regulations. Title 33, Section 3715(c) through (t). Furthermore, I untIM1211d and am <br />in compUance with the requirements (statutes, regulations, and local prdipancex) applicable to underground storage tanks. <br />TANK OWNEERNAME-- <br />TANK OWNER TM -E; <br />TANK OWNER SIONA <br />INSTMICTIONM+ <br />OWN-P-R_PHONE ! 9xs� ��1De1 <br />i7�TE•����/ ��/ <br />1. Report the namels) of the Dcmignawd UST 0pemtttir(e) as rtptstered with the International Code t aimcil (ICC). JCC. eertifl.ation <br />inlamxtion is av"able on -fine at; wNN.ieciafe.orglrieorlaelrreh.html• Search ror "California UST S),swm Operators. - <br />2, Submit Ibis completed form to the local agency (NIT regulates this faciliry-s Us7s- linidoe, memheT agency juri,5dictions and <br />contact information are listed on -lint at: www.Unidoes.org/members/wboregulateswhat.htmi- Contatr infomlation for other <br />local agencies within California is available at. ww-w-swreb.ea.Rovlc%,phoneluxticontactsJdocs/local-agency UsLxis. <br />j_ ?� CCR tr?713(H) rCyttrro.4 thact �ou n��1iT+' IhC local aecncr• of any ch,ut�r, to this informatiun �vzahin .�0 cies)•. Ill dtic clue of chanLte, <br />I S•063. 1•`I IIA -IM; <br />