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FROM : FAX NO. :2099550601 ov. 19 2007 03:19PM_ P1 <br /> Owner Statements of Designated.Underground Storage Tank (UST) Operator <br /> and Understanding of and Compliance with UST Requirements <br /> ff <br /> me:Quick N 9tot MartFacility ID i#dre s 2057 S.EiDorado St Reason for Submitting this Foran(C:heck One) <br /> Stockton.CA.95206 X Change of Designated Operator <br /> one#:(209)46 6474 0 Update Certificate Expiration Date <br /> Desi aced UST O <br /> or(s)for this Facility <br /> PRIMARY <br /> Designated Operator's Nance:Karen R Arnaiz ;Expiration <br /> tion to UST l;acility(,Check One) <br /> Business Name(If d j,�erent,i om above): <br /> wner 0 Operator ❑ Employee <br /> Designated is Phone#:(209)518-4$36 ervice Technician X Third-Party <br /> International Code Council Certification#:5266643.UC Date:07/X6/09 <br /> ALTICr;NATE 1 fora! <br /> Designated Operator's Narne: Relation to UST Facility(Check One) <br /> Business Name(!f different from above); ❑ Owner ❑ <br /> Operator D Employee <br /> Designated Operatar's Phove#: Q Service Technician O Third-P" <br /> International Code Council Certification#i: Expiration Dale: <br /> ALTERNATE 2 (Opdonol) <br /> Designated Operator's Name: <br /> Relation to UST facility(Check one) <br /> Business Name(if different from above); <br /> © Owner 0 Operator ❑ Employee <br /> l;Qgnated Operator's Phone#: ❑ Service Technician p Third-Petty <br /> International Code Council Certification#: Expiration Date- <br /> 1 certify that,for the facility indicated at the top of this page,the individual(S)listed above will <br /> serve as Designated UST Operator(s). The individual(s)will conduct and document monthly <br /> facility inspections and annual.facility employee training, in accordance with California Code of <br /> Regulations,title 23, section 2715(c)-(f). <br /> Furthermore,I understand and am in compliance with the requirements(statutes, <br /> regulations, and local ordinances)applicable to underground storage tanks. <br /> NAME OF TANK OWNER(Please Priht): <br /> a b <br /> 7 <br />