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11/�0/2009 16:30 FAX 2093683234 GEORGE KISHIDA INC <br />0 <br />Afforda-Te$t 416 �nd Street Gait. Ca. 95632 <br />Z 003 <br />209 744-0113 209 744-0116 FAX <br />Owner bUtemertts of Designated Underground Storage Tank Operator <br />and 'Understanding of and Compliance with UST Requirements <br />Fadlity Name. k L <br />Faellity-m- <br />Add"= j Cft q,5 Z40 Reasonfordiiisforrn: <br />Fatility PhoneM. 49 Chailge of D&signated Operator <br />_qDq -3ife- 04PO-31 13 Update Certificate Expiration Date <br />MSIGNATED UST OPMATOR FOR THU FACILITY: <br />PRIMARY <br />Designated OpeMors Nanie: <br />LYLE D. ND010 <br />Service 1'echnician <br />Business Name: <br />AFFORDA-TEST <br />fcc # 5249115, <br />Desirated Operator's Phone 4: <br />209744-0112 <br />Expiration Date: Eo�i na <br />ALTERNATE I <br />Designated Operator's Name: <br />DAVTD A. WINKLER <br />$ervice Technician <br />Bttsiness Name., <br />APPORDA-TE$T <br />Ice # 5263373. <br />EX'signated OPerator's Phone -4; <br />209744-0112 <br />-Smaiotion Datq.,- a= 10 <br />ALTERNATE z <br />Designated Operators Name: <br />ZANE �L NEWX0 <br />ServiceTechnician <br />Busiriess Name- <br />AFFORDA-TEST <br />[cc # 5263322 - <br />Designated Operator's Phone 6: <br />209744-0112 <br />ExpimtionDate-, 3/14/2010 <br />ALTERNATE 3 <br />Designated Operator's Name: <br />IFELIX Q RAKREZ <br />Service Technician <br />Busi.ness Name: <br />AFFORDA-TEs'r <br />ICC 1* 5273934. <br />Designated Operator's Phone 9; <br />209 744-0112 <br />Expiration Date: 6/21120 10 <br />II certify that, for the facility indicated at the top of this page, the individuals libled above will serve as Designated UST <br />Operators. The individuals will conduct and document monNy facility inspections and annual facility employee training, <br />accordance with California Code of Regulations, title 23, section 2715 (c) - (f). <br />IFurthermore, I understand and am in compliance with the requirements (statutes, regulations, and local <br />ordinances) applicable to underground storage tanks. <br />I NA ME OF TANK OWNER (P ri n t); r— C-- L- L- ( I Z --j <br />Wll"c n;VIUAD) 709 GYM . —15 FF 0 - <br />DATE: <br />OWNER'S PHONE; --7-D -eI- <br />NOTE., <br />1) SUBMrr THTS COMPLETED FORM TO THE LOCALAGENCY (NOT STATE WATER RESOURCES CONTROL BOARD) AFTE R. <br />SIGNING THE LOCAL AGENCY LIST IS AVAILABLE, AM www.wuftrboards.ce,govAtWcontacWcupa__�agyshtmi, <br />2)NOTIFYTHELOCALAGEN(If OFANYCHANGESTOTHIS INFORMATION WITWN 30 DAYS OFTHECHANGE, 3(.g;- 1 2-54 <br />'roo @ yva 02:60 tz/11 600z <br />