Laserfiche WebLink
May 04 11 03:13p Reliable PetroleumA 209-845-8953 p.19 <br />Owner S atements of Designated Underground Storage Tank (UST) Operator <br />d Understanding of and Compliance with UST Requireiir; is 0 , <br />Facility Name: G S DEPOT Facility tD #. <br />Facility Address: 330 E. Yosemite Avenue, Manteca CA 95336 <br />Reason for Submitting this Form fCheck One) <br />Facility Phone #: 09-g�(t332 Change of Designated Operator <br />X Update Certificate Expiration Date <br />Designated Operat <br />Business Name (if <br />Designated Operat <br />International Code <br />ALTERNATEI( <br />Designated Operate <br />Business Name Qf <br />Designated Operate <br />International Code <br />ALTERNATE 2 <br />Designated Operatc <br />Business Name (ffc <br />Designated Operate <br />International Code <br />Designated UST Operators for this Facility <br />s dame: Robert Barnhart Relation Ea I ST Facility (Check One) <br />�erent from above): Reliable Petroleum Services Inc. <br />Q Owner D Operator ❑ Employee <br />s Phone #: 209=604-9336 X Service Technician ❑ Third -Party <br />)uttcil CefdrIication #: 5252540 -UC Expiration Date: I2-23-2011 <br />Name: Guadalupe Sanchez <br />rent from above): Reliable Petroleum Services Inc. <br />Phone #: 209-604-9363 <br />incil Certification #: 5250451 -UC <br />Name: <br />gent from above): <br />Phone #: <br />Certification #: <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator D Employee <br />X Service Technician 7 Third -Party <br />Expiration Date: 01-29-2013 <br />Relation to UST Facility (Check One) <br />® Owner ❑ Operator 0 Employee <br />0 Service Technician D Third -Party <br />Expiration Date: <br />I certify that, the facility indicated at the top of this page, the individuals) listed above will <br />smote as i?ese UST operator(s). The izxlividual(s) will conduct anti document monthly <br />facility ' Ds and annual, facility employee Mining, in accordance with California Code of <br />I2egulatiom ' e 23, =don 2715(c) - (f), <br />Furthermore,'understand and am in compliang with the requirements (statutes, <br />nValations, a local ordinances) a erground sto a tanks. <br />. j <br />i NA,AI E OF T&N owNER (Pleas a Prwtk I <br />{ SIGNATURE OF TANK OWNER. <br />I , <br />DATE. <br />OWIVER"S PHQ E #: -40 9 -- <br />i <br />NOTE: I) SUBm THIS CO�iNIPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER <br />RESOURCES COTROL BOARD) BY JANUARY I, 20o. THE LOCAL AGE�tcY LIST ISAVAILABLE <br />3T: .. . <br />2)N0TFFVT"E:I7A AGENCY OF A" CHANGES TQ THIS INFORMATION WITHIN 30 DAYS <br />OF THE C,HANG <br />