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May 04 11 03:04p Reliable Petrol eu 209-845-8953 p.4 <br /> • <br /> Owner Sttements of Designated Underground Storage Tank (UST) Operator <br /> anUnderstanding of and Compliance with UST Requirements <br /> Facility Name:liar mer Lane Oil-Chevron Facility ID#: <br /> Facility Address: 3 iO4 W.Hammer Lane,Stockton CA 95206 Reason for Submitting this Form(Check One; <br /> Change of Designated Operator <br /> Facility Phone##: 9478-9293 X Update Certificate Expiration Data <br /> Designated UST Overator(s) for this Facilitv <br /> PRIMARY <br /> Designated Operat 's Name: Robert Barnhart Relation to UST Facility(Check One) <br /> Business Name(If >ierent from above):Reliable Petroleum Services Inc. ❑ Owner C Operator O Employee <br /> Designated Operat 's Phone#: 209-604-9336 X Service Technician 0 Third Pang <br /> International Code Founcil Certification#: 5252540-LC Expiration Date: 12-23-2011 <br /> ALTERNATE 16 trona! <br /> Designated Operat 's Namc:Guadalupe Sanchez Relation to UST Facility(Check One) <br /> Business Name(!ff fferenl from above):Reliable Petroleum Services Inc. G Owner O Operator O Employee <br /> Designated Operat 's Phone#:209-604-9363 X Service Technician ❑ Third-Party <br /> International Code ouncil Cenification#l:5250451-UC Expiration.Date:01-29-2013 <br /> ALTERNATE 2 Optional) <br /> Designated Operat 's Name: Re!ation to UST Facility(Check One) <br /> Business Mame(1 lVferentftom above): p Owner O Operator ❑ Employee <br /> Designated Operat is Phone#: Q Service Technician 13 Third-Party <br /> International Code Council Certification#: Expiration Date: <br /> I certify xbrL for the faccility indicated at the top of this page, the individual(s) listed abo-^e will <br /> serve as lies gnated UST Operator(s). The indi-Adual(s)will conduct:and document monthly <br /> tacility inspt ations and am al facility employee training, in accordance cath California Code of <br /> Regulations,titIe 23,section 2715(c)-(f)- <br /> Mi rtherrno ,I anderstand and am in compliance frith the requirements (stxtuttes, <br /> E'eglatiot:s and lata) ordinances)applicable to underground storage tanks. ! <br /> 114AME OF T NX OWNER(Please Print): /Lt,t,,, <br /> SIC-NATURE DF TAINK OWNER: <br /> 3 <br /> nA-rv. OWNER'S PHONE M I L( J <br /> l <br /> i <br /> NOTE: 1)SLII MILT THIS COMPLETED FORM TO THE LOCAL AGENCY(.Nc)7r THE sTA-r E»WATER <br /> RESOFiRCES CONTROL BOARD)BY JANUARY 1,3lltl5.THE LOCAL AGENCY LIST IS AVAILABLE <br /> 2)NOTIFY T 1E LOCAL AGENCY OF ANY CHANCES TO THIS INFORMATION WITHIN 34 DAYS <br /> OF THE Cf3 45.F- <br />