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OCT -16-2008 11:43 FROM:CHOL/MFT 209 476 3096 TO: 94683433 P.2/2 <br />-� Owner Statements of Designated Underground Storage tank (UST) Operator <br />and Understanding of and Compliance with UST Requirements <br />Facility Name: Kaiser Stockton Facility ID #.1 d <br />Facility Address: 7373 West Lane Reason for Submitting this Form (Check One) <br />Stockton, Ca. 95210 O Change. of Designated Operator <br />Facility Phone #: _ ❑ Update Certificate Expiration Date <br />Designated UST Operator(s) for this Facili <br />®uINAADV <br />Designated Operator's Name: <br />Thomas Lce Hingston II <br />Relation to UST Facility (Check One) <br />fl Owner f1 Operator rl Employee <br />U Service Technician Eti `I hird-Party <br />Business Name, (Ifdffferentfrom above): C-F._S. <br />Designated Operator's Phone #: 707-987-4770 <br />International Code Council Certification #: <br />53010(13 -UC <br />Expiration Date: 12-28-2008 <br />Desipatcd Operator's Name: <br />Tom Hingston <br />Rclation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Scrvicc Technician El 'I11ird-Party <br />Business Name (If d(Iferent,fromabove): C.ir'-S <br />Designated Operator's Phone N: 707-9874770 <br />international Code Council Certification #: <br />5243778 -UC <br />F,xpiration Date: 01-18-2010 <br />AL'1'ERNjVfE 2 (Optional) <br />Designated Operator's Name: <br />Business Name (If d((ferenr /i-om above): <br />Designated Operator's Phone tl: <br />International Code Council Certification #: <br />ALTF.RNATF i Mnlinnid) <br />Rclation to USI Facility (Check One) <br />❑ Owner ❑ Operator ❑ Fmployee <br />❑ Service l echnician U 'third -Party <br />Expiration Date: <br />Designated Operator's Name: <br />Rclation to UST Facility (Cheek One) <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Service Technician n Third -Party <br />Business Natne (If(4(/erenr from above): <br />Designated Operator's Phone #: <br />International Code Council Certification #: <br />Expiration Late <br />I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as <br />Designated US'l` Operator(s). The individual(s) will conduct and document monthly facility inspections <br />and annual facility employee training, in accordance with California Code of Regulations, title 23, section <br />2715(c) - M. <br />Furthermore, I understand and am in coimpliance with the requirements (statutes, regulations, and <br />local ordinances) applicable to underground storage tanks. <br />NAME OF TANK OWNER. (Please Print): <br />SIGNATURE OF TANK OWNER. <br />2) NOTIFY Tor, [ACAL AGENCY OF ANv CHANG S IX) TIRLS hNFORi%tn0N WT FH1N 30 DAYS OF THE CHANGE <br />