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RECE VEE) <br /> A -JrdLw - 416 2nd Street Phone;(209)744-0112 <br /> JAII]Ior-, aGalt,Ca 9W2 Fax:(209)744-0116 APR 0 7 014 <br /> affords C49ofteom.net <br /> Owner Statements of Designated Underipround Storage Tank Ope ENTAL HEALTH <br /> and Understanding of and Coni Bance with UST Requirements DEPARTMENT <br /> Facility Name: Quick N Stop Market Facility 0: 1463-1 PO# <br /> Addrea: 2057$.)&1 Dorado Street Stockton CA 95206 updated Owners Statement <br /> Facility Phone#:209-670920 ❑Chsop 0 Destasted op is <br /> ❑ New Deftut-d Optmftr <br /> DESIGNATED UST OPERATOR EOR IMS EAQPW. <br /> PR.MARY <br /> 0"kaxted 0peratw,6 N ZANE NIMMO Service Technician <br /> Business Nam: A TEST ICC#: 5263322-UC <br /> Designated Operator's Phone: 209-7440112 Expiration Date- 3/3/16 <br /> ALTERNATE <br /> Designated Operator's Name: FELIX RAMIREZ Service Technician <br /> Business Name: A TEST JCC#- 52733934-UC <br /> Designated Operator's Phone: 209-744-0111 Expiration Date: 3/3116 <br /> ALTERNATE 2 <br /> Designated Operator's name: DAVID WINKLER Service Technician <br /> Business Name: RDA TEST ICC#; 5263373-UC <br /> Designated Operator's phone: 209-744-0112 Expiration Date., 3110116 <br /> ALTERNATE3 <br /> Designated Operator's Name: EDWARD STEARNS Service Technician <br /> Business Name; AFFORD,Aa TE$T ICC#-. 5250492-UC <br /> Designated Operator's Phone, 209-744-0112 Expiration Date., 3/3/16 <br /> I tertW that,for the facility Indicaw at the top of this page,the individuals listed above will serve as Designated UST <br /> Opwaton. The individuals will conduct and document monthly facility inspections and annual facility employee <br /> tMiAlm In <br /> Accordance with California Code of Regulations,title 23,section 2715(e,)_(f). <br /> vadmVLand and am in empit4ugs with the requirements(statutes,regulations'and lom' <br /> ordi"Reeg) applicable to andeWousid gtorip tanks. <br /> NAME OF TANK OWNER/0"mor(PiUt): <br /> SIGNATURE OF TANK OWNER/Operaktor; <br /> DATE%, 4— <br /> OWNERS pfloNt; <br /> z WAL <br /> NMI. 1) SUBMIT THIS CC)W*R-F-'MD 5,01tM TO THE LOCAL AGENCY jNOT SWRCB)A11TtR SIGNINQ THE <br /> AOCKN LtST IS AVAILAWA AT". 30 DAYS OF THE <br /> 2) Na EFTllg LocAL 4GENCY OF An CHANGER TO THIS JNWRMAT <br /> CHANGL <br /> OFFICE., 14-1-11 ' Date Scanned*. <br /> County; <br /> SJC— to FMalled <br />