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OCT -20-2007 08108A FROM: P.2 <br />Jul 29 1a 04t38p R ords Test [2#'74401V <br />744-� � _ P.1 <br />nordaAMAIN gt 416 2*d Street Phonon (209) 74"112 SEP <br />,Tesalt, Ce 9M2 Fax: (209) 744.0116 <br />a!M'orda soft ommet Z 10 <br />Owner Statements of Designated Underground Storage Tank Opamt-or <br />and Understanding of and Compliance with UST RequiremenU <br />Facili Name: Canepa's Car Wash Facill #; <br />Address: 642 N HunterStocktonCA <br />Facility Phone #: ❑ Chnage afoesignand Operacor <br />® Now vesignaled Operator <br />DE it 2t I►TED UST OPERATOR. FOR TIAs FAA&1L, <br />Designated Opwator's Name, <br />ZANE NIMMO <br />Service Teehniclan <br />43usiness Nertan: <br />AFFORDA TEST <br />ICC 4: 9263322 -UC <br />Dirgignaia4 Opantior's Picone: <br />209-744-0111 <br />Expiration Data: )WI2 <br />ALTERNATE I <br />Designated Openstor'9 Nmrw. <br />FELIX RAM INI4 Z <br />Scrvicx Technician <br />aLwom Nam: <br />AFFORDA TEST <br />ICCO: 32733934 -UC <br />DmignuteJ 's Phrnx: <br />209.744.0112 <br />expiration Onto: 4/7/12 <br />Designated 0pomter's Names <br />DAVID iNKL R <br />Sorvice Technician <br />®tainess N <br />AlPFORDA TEST <br />ICC P. 5263373 -UC <br />Designated Operator's Phontr <br />209.744-0112 <br />Expiration Onto: 3124/42 <br />ALTERNAT4 3 <br />Rcsigaatcd Operator's Name: <br />LYLE NIMMO <br />Service Technician <br />Business Name: <br />AFFORDA TEST <br />iCC N: 52491 19 -UC <br />Designated Optntar*s Phone, <br />209-744-0112 <br />Expiration Oa.. 244/12 <br />I certify that. for tho facility Indlcatcd as tho top of this page, the individuals Ilsted above will serve as Designated UST <br />Operators. The individuals will conduct and document monthly facility inspections And annual lhotl1W employer, training, in <br />Accordance with California Code of Regulations, tido 23, section 2715 (c) — (1). <br />Furthermore, I understand and ass In compliance with the requirements (slatotcs, regaiatb®s, and local <br />Ordinances) applicable to underground storage tanks. to <br />NAME OF TANK OWNER (Print): 'Rema And. A ®h %�Q-rtiP <br />SIGNATURE OF TANK OWNER: � '9'd'�gu <br />DATE; - 1i -1 D OWNERS PRONE: <br />NO'rs: <br />1) SUBMIT TOM COMPLETED FORM TOTI-IR LOCAL AGENCY (NOT SWRCR) AFTER SIGNING, THE LOCAL AU12NCV <br />I.i3T 1S AVAILABLE AT: = M2t�srrrR.Ga- �ye.it Axl. <br />2) NOTIFY THE LOCAL AGENCY Of• ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE, <br />OFF/CE; <br />County-, Date Famed: Date Scanned: <br />9001) liars 4- TV3 85:CT 60/60 OTOZ <br />