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Owner Statements of Designated Underground Storage Tank (UST) Operator <br />and Understanding of and Compliance with UST Requirements <br />F Facility Name: Wilson Way Chevron <br />ar"M tfM I I <br />Facility Addrm. 437 N. Wilson Way, Stockton, CA <br />i 0 Charige of Designated Operator <br />x Update Certificate Expiration Date <br />MIT <br />ra-MITITTMA <br />1 Designated operatoes Name: Alex Jabbari <br />on to UST Facility (Check One) <br />0 Owner 0 Operator 0 Employee <br />X Service Technician 0 Third -Party --- <br />Name (If differentfrom above): Norcat Peftvkwn Seryke Inc <br />-Business <br />Designated Operatoes Phone#: 925-389-1262 <br />to M -,.I mmmm EA <br />Expiration Date: _j <br />Designated Operatoes Name: <br />1 0 Owner C3 Operator 0 Employee <br />0 SerTice Technician 0 Third -Party <br />Business Name (If differentftom above): <br />Designated Operator's Phone #: <br />to M -,.I mmmm EA <br />Expiration Date: _j <br />I'll I I "I'll G! I I - <br />Designated Operator's Name: <br />ReMon to UST Facility (Check One) Mi <br />0 Owner 0 Operator 0 Employee <br />0 Service Technician 0 nird-Party <br />Business Name (ydifferentftom above): <br />Designated ites Phone #: <br />111177 M-71MMIMM71 <br />Not I <br />�M_IIz;MTI_m Mtt'l <br />E177 <br />Regulations, title 23, section 2715(c) - (f). <br />regulations, and local ordinances) applicable to underground storage tan" <br />DATE: OWNEWS PHONE#: <br />AT: <br />2) NOTWY THE LOCAL AGENCY OF ANY CHANGES TO TH14MMA4ATION ik�f4 30 DAYS <br />OF THE CHANGE. <br />DEC 16 2011 November 2004 <br />