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-'-1=U-T <br /> 4162"'Street Phone:(209)744-0 1 <br /> ff rd — Gait,Ca 95632 Fax:(209)744-0116 2Q1� <br /> afforda softcont'net <br /> mm Owner Statements of Designated Undergroulnd Storage Tank Operator <br /> and Understanding of and Compliance with UST Requiremen <br /> Facility Name: <br /> _W Facility ID i'0# <br /> Address: Updated Owners Statement <br /> Change of Designated Operator <br /> New Designated Operator <br /> Facilitl Phony* <br /> DESIGNATED UST OPERATOR FOR THIS FACT SIT.. <br /> PRIMARY <br /> Designated Operator's Natne: Asti NIMMO Service 52633 2-U <br /> Business Mame: AFFORDA TEST ECC#: on Datet 3/ <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3/3116 <br /> ALTERNATE1 <br /> Designated Operator's Name: FELIX RAMIREZ Service Technician <br /> Business Name: AFFORDA TEST ICC#: 52733934-1-iC <br /> Designated Operator's Phone: 209744-0112 Expiration Date: 3/3116 <br /> ALTERNATE 2 <br /> Designated Operator's Name: DAVID WINKLER Service Technician <br /> Business Name: AFFORDA TEST ICC#: 5263373-LTC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3/10/1.6 <br /> ALTERNATIE 3 <br /> Designated Operator's Name: EDWARD STEARNS Service Technivian <br /> Business Name: AFFORDA TEST ICC"#: 5250492-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date: 3/3116 <br /> 1 certify that,for the facility indicated at the top of this page,the individuals listed above will serve as Designated UST <br /> Operators, The individuals will conduct and document monthly facility inspections and annual facility employee <br /> training,in <br /> Accordance with Califs rr is Coda-of Regulations,title 23,section 2715(c)--fD. <br /> Furthermore,I understand and am in compliance with the requirements(statutes,regulations,and local <br /> ordinances)applicable to underground storage tanks. <br /> NAME OF TANK OWNER/operator(Print): <br /> r° <br /> SIGNATURE 4F TANK OWNER/Operator: <br /> DATE.: _ OWNERS PHONE: " <br /> NOM: <br /> I) st nxll°I,THIS C,'t>lvll'1,F"TF:1t FORMTO THE LOCM.AGENCY(NO'1'swttCll)AF"t1lt StcralNG,THE 1~aCA1. <br /> AGENCY 1 IST IS VAILAnt.EAT to r <br /> 2) N!C)TI Y TltE l.,OCAL AGENCY OF ANVY CHANGES TO THIS INFORMATION ION°WITHIN 30 DAYS OF THE <br /> CHANGE. <br /> OFFIM <br /> County: JC Bate Faced: Date Scanned: Date E,ttlalled <br /> Uc' <br />