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L <br /> --1 <br /> ED s TO:7440116 P <br /> .2 <br /> 002 <br /> 40 <br /> SEP <br /> Owner Statements of Designated Underground Storage Tank Operator <br /> �,;q jOAOUIN COUNTY nd Understanding of and Compliance with UST Requirements <br /> a <br /> TMENI <br /> TAdcb <br /> -K�imn Aw this forni.- <br /> (P q�o%� NW�f, IA�Lit n-AP-f, C3 Changc of Designated Operstor <br /> Facility Phimc#: (o M UpdateCertificate Expiration Date <br /> k— <br /> DE.siGT4ATF,Du,vropEoRAToitFC)R'fMSFAQ II,ITY'- <br /> PRIMARY <br /> nc.6grmted Operator's Name: LYLE D.NIMMO SvrviwTwbnician <br /> Business Namc: AFFORDA-TEST ICC H 5249115-UC <br /> Designated oEcrator's Phone 209 744-0112 L.,xpiration Bate: 7/112009 <br /> ALTERNATE I <br /> Dmignated"ieratni's Nanic. VAVT V A. TN LER Service Technician <br /> Hu4incssNainc; AFFORDA-11ST Icc# 5263373-tJC <br /> Dusignated Operator's Plione ft: 209744-0112 <br /> ALTERNATE 2 <br /> Vosigil"Ied Opci-dwr's Name: ZANE A.NY Ssarvitx1lechniciall <br /> Rusinms Name: AFr-ORDA-'l'b$T Icc It 5263322-11C <br /> Msigmutcd Opvrfttof's Phone 4; 209 744-01 1 2 Ex-Eiration Date: 3/14/2010 <br /> ALTHNNA,rp 3 <br /> rx-signkitud Operator's Na c: WITX Ir.RAMMEZ Servicu Technician <br /> Bu0numNuinc. AFFORDA-TEST )cc# 5273934-tj6 <br /> Designated Operator's Phonc it: 2M 744-0112 L;xplration nate: 6/21/2010 <br /> I ccrtity that,(&the facility indi"tcd at the MP Of this page,the ladividualm lifiu-d above will serve ai Oe-signatted UST <br /> Operators. The individuaN wi)l coMuct and document monthly fiteility inspections and annuni facility eft,1110YOe Mining,in <br /> accordance with California Code of Regulations,title 23,suction 2715(C)-(t). <br /> Furthermorc, I understand and am In compliance wjLh the requirements (stuttateS, regulstiOnN &Rd 10cull <br /> ordinances) applicable to underground storage tanks. <br /> NAME OF' IAN OWKER (Print): <br /> SI(;NA'l*VRF. OF TANK OWNER:-> ' <br /> DATE: OWNER'S PHONF;10 <br /> NOrF-- <br /> I)qIMMITTHISCOMPLIRTED TO[ RMTOTHE LOCALAGpjqCy(NOT gTATE WAIXit RL4A)vl4C:F.S MM MOLBOARD) <br /> AIFFERSIGNING THKIDCAI.,ACtENCVU.%TISAVAILABLV.Xf* <br /> 2)N WCAg,AGro.NCV OVA NYCIHANGMTOTHIS IN AM WFF11IN 30I>AVSOMECHANGL <br />