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UNDERGROUND STORAGE TANK <br /> DESIGNATED UNDERGROUND STORAGE TANK OPERATOR IDENTIFICATION FORM ( Page 1 of 1 ) <br /> Every underground storage tank ( UST) facility must have at least one designated UST operator. A copy of this completed form must be <br /> electronically submitted via either the California Environmental Reporting System (CERS) or an equivalent local Unified Program Agency <br /> electronic reporting portal within 30 days of: 1 ) an installation of a UST; 2) a change in owner or operator of the UST; or 3) an addition or <br /> change of an individual performing designated UST operator inspections or facility employee training at this facility. [California Code of <br /> Regulations, Title 23, Division 3, Chapter 16, Section 2715(a) .] <br /> Type of Action <br /> ❑ New UST Installation E] Change of Owner or Operator Z New or Change of Designated UST Operator <br /> I . FACILITY INFORMATION <br /> Business Name (same as Facility Name or DBA-Doing Business As) CERS ID <br /> YRC 813 10181485 <br /> Business Site Address City ZIP Code <br /> 1535 E . PESCADERO AVE TRACY 95304 <br /> The individual(s) listed below will conduct and document the facility inspections and facility employee training for the facility listed above in <br /> accordance with California Code of Regulations, Title 23 , Division 3, Chapter 16, Sections 2715(c) and 2716. <br /> II . DESIGNATED UNDERGROUND STORAGE TANK OPERATOR(S ) INFORMATION <br /> Name of Designated UST Operator (Print as shown on the ICC certification.) ICC Certification # <br /> Catherine Riccomini 8018933 <br /> Mailing Address Phone # <br /> 16250 Meacham Rd , Bakersfield , CA 93314 ( 800) 339-9930 <br /> Name of Designated UST Operator (Print as shown on the ICC certification.) ICC Certification # <br /> Richard Reed 8214306 <br /> Mailing Address Phone # <br /> 16250 Meacham Rd , Bakersfield , CA 93314 (800) 339-9930 <br /> Name of Designated UST Operator (Print as shown on the ICC certification.) ICC Certification # <br /> Jodie Arvizu 9096574 <br /> Mailing Address Phone # <br /> 16250 Meacham Rd , Bakersfield , CA 93314 (800) 339-9930 <br /> Name of Designated UST Operator (Print as shown on the ICC certification.) ICC Certification # <br /> Jason Woods 8492093 <br /> Mailing Address Phone # <br /> 16250 Meacham Rd , Bakersfield , CA 93314 (800) 339-9930 <br /> Name of Designated UST Operator (Print as shown on the /CC certification.) ification # <br /> Om7177 <br /> ert <br /> ero Garcia II 8867859 <br /> Mailing Address Phone # <br /> 16250 Meacham Rd , Bakersfield , CA 93314 (800) 339-9930 <br /> Name of Designated UST Operator (Print as shown on the ICC certification.) ICC Certification # <br /> Michael Stromecki 8339168 <br /> Mailing Address Phone # <br /> 6292 San Ignacio Ave . Suite E , San Jose , CA 95119 (669 ) 200-0678 <br /> Name of Designated UST Operator (Print as shown on the ICC certification.) ICC Certification # <br /> Erik Rogers 9367164 <br /> Mailing Address Phone # <br /> 6292 San Ignacio Ave . Suite E , San Jose , CA 95119 (669) 200-0678 <br /> Name of Designated UST Operator (Print as shown on the ICC certification.) ICC Certification # <br /> Mailing Address Phone # <br /> Name of Designated UST Operator (Print as shown on the ICC certification.) ICC Certification # <br /> Mailing Address Phone # <br /> Name of Designated UST Operator (Print as shown on the ICC certification.) ICC Certification # <br /> Mailing Address Phone # <br /> Attach additional page(s) containing all the information in section 11 if more alternates are used. <br /> ID = Identification, ICC = International Code Council <br /> j UN -062 www. unidocs.org 1 /1 - Rev. 06/14/18 <br />