Laserfiche WebLink
Appendix XI <br /> Underground Storage Tank <br /> Designated UST Operator Identification Form <br /> TYPE OF ACTION ❑ New UST Installation ® New/Changed Designated Operator <br /> 1. FACILITY INFORMATION <br /> CERS ID Facility Name <br /> 10397599 Sutter Health Tracy Hospital <br /> Facility Address City ZIP Code <br /> 1420 N. Tracy Blvd. Trac 95376 <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Print names exactly as shown on the ICC certification. <br /> Name of Designated UST Operator ICC Certification <br /> Chad White 8152115 <br /> Mailing Address Phone <br /> P.O. Box 4208 Sonora Ca, 95370 209-532-7320 <br /> Name of Designated UST Operator ICC Certification <br /> Isaac Anderson 8146912 <br /> Mailing Address Phone <br /> P.O. Box 4208 Sonora Ca, 95370 209-532-7320 <br /> Name of Designated UST Operator ICC Certification <br /> Matthew Hughes 8889450 <br /> Mailing Address Phone <br /> P.O. Box 4208 Sonora Ca, 95370 209-532-7320 <br /> Name of Designated UST Operator ICC Certification <br /> Mailing Address Phone <br /> Name of Designated UST Operator ICC Certification <br /> Mailing Address Phone <br /> Name of Designated UST Operator ICC Certification <br /> Mailing Address Phone <br /> Name of Designated UST Operator ICC Certification <br /> Mailing Address Phone <br /> Name of Designated UST Operator ICC Certification <br /> Mailing Address Phone <br /> Additional copies of this page may be attached. <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, UST = Underground Storage Tank <br /> Page 1 of 1 <br />