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2m-s RECE, SEOmMlaStatements of Designated Underground Storage Tank Operator SAN JOAQUAgONVnderstanding of and Compliance with UST Requirements Facil ENVI GAIM&ITAI C% Facility#: Address- Reason for this form: nco��)L\—Ooo-,A �,Acrk\, IA)�— E3 Change of Designated Operator Facility Phone#: q 42 -,2(o c( Update Certificate Expiration Date DESIGNATED UST OPERATOR FOR THIS FACILITY. PRIMARY Designated Operator's Name: LYLE D.NIMMO Service Technician Business Name: AFFORDA-TE$T ICC# 5249115-UC Designated Operator's Phone#: 209 744-0112 Expiration Date: 7/1/2009 ALTERNATE Designated Operator's Name: DAVID A.WINKLER Service Technician Business Name: AFFORDA-TE$T ICC# 5263373-UC Designated Operator's Phone#: 209 744-0112 Expiration Date: 3/27/2010 ALTERNATE 2 Designated Operator's Name: ZANE A. NIMMO Service Technician Business Name: AFFORDA-TE$T ICC# 5263322-UC Designated Operator's Phone#-: 209 744-0112 Expiration Date: 3/14/2010 ALTERNATE 3 Designated Operator's Name: FELIX G RAMIREZ Service Technician Business Name: AFFORDA-TE$T ICC# 5273934-U6 Designated Operator's Phone#: 209 744-0112 Expiration Date: 6/21/2010 1 certify that,for the facility indicated at the top ofthis page,the individuals listed above will serve as Designated UST Operators. The individuals will conduct and document monthly facility inspections and annual facility employee training,in accordance with California Code of Regulations,title 23,section 2715(c)-(f). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Print): k D-- 7� SIGNATURE OF TANK OW CE : DATE: q OWNER'S PHONE: NOTE: 1)SUBMIT THIS COMPLETED FORM TO THE LOCALAGENCY(NOT STATE WATER RESOURCES CONTROL BOARD r AFTER SIGNING THE LOCALAGENCY LIST IS AVAILABLE AT. www.waterboards.ca.gov/ust/contacts/CLipa aevs.html. 2)NOTtFYTHE LOCALAGENCY OFANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OFTHE CHANGE.