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11"-%-;FEIVED <br /> 416 e Street Phone;(209)744-0112 <br /> Afforda-Te Q4 Ca 95632 Far,(209)744M16 <br /> t— <br /> affardaCAsofteonmet APR q 7 2014 <br /> Owner Statements of Desismated Underground Storage Tank Operator <br /> and Understauftof and CoMpfiance with UST BMui:Lrements ENVIRONMENTAL HEALTH <br /> _ <br /> 7 Name: VDP—PAC M& Facility#: — pi)4 DEPARTM NT <br /> Address: 351 N Beckmen Rd Lodi CA 95240 Updated Owners fttement <br /> Facility ftone#-.20-944-9115 EICIumse of DesivxtO Operator <br /> 0 N9W Dedpow OP-Mar <br /> pEsjGNATER UST()MRATOR FOR T1 S FA <br /> P <br /> Reftnatgd Operator's Name: ZONE NEOMO Sffvice Technician <br /> Business Name. AFOORDA TEST ICC#. 5263322-UC <br /> Desi ted Operator's Phone: 209-744-0112 Expiration Hate: 3W6 <br /> ALT Z"ATE I ervice Technician <br /> Designgted Operator's Name; FEMPEAMIREZ 8 <br /> Badness Name., AFFORDA TEST ICC#: 52733034-UC <br /> Depigopted Operator's Phone'. 209-744-0112 Fapyation Date-. 313/16 <br /> ALTIRNATE2 <br /> Designated Operator's Name: DAM VVEWLER Service Technician <br /> Badness Name., AFFORDA TEST ICC M 5263373-M <br /> Designated Operator's Phoue, 209-744-0112 Expiration Date: 3/10116 <br /> ALT ERNATE 3 <br /> Designated Operator's Name: EDWARD STEARNS SWAM Tedini 'an <br /> Badness Nanie: AWORDAMT JCC#: 525049.2-UC <br /> Designated operator's Phone: 209-744-0112 Expiration Date; 3/3116 <br /> I certify that,for the facility Indicated at the top of this page,the individuals listed above will Wvl 29 DesigRated UST <br /> operators. Tko individnah wM conduct and document muthly facility hASPeWOBs and*ftAusl facluty employee <br /> training,in fatlon&,title 23,sectIon 2715(6)—(f). <br /> Fu <br /> with California Code of Rego <br /> Furowrokore,I understand and am In compRance with the requiraments(statutes,regulations,and loco <br /> Ordinances) applicableto underground Storage tanks. <br /> NAME Of TANK OWNIR/Operator(Wint): Vq-AJDC--Mt, e7V7W-A1aS'fS �- <br /> SIGNATME OF TANX OWNER/Operator' <br /> DATE,A/za OVVNERS PHONE; <br /> 1) SUBNUT THIS CoMpLr=TO RM To THE LOCAL AGXNCY(NOT SWRCM AV=SIGNIXG.THE LOM <br /> AGM Mr IS AVAZA=AM water lusticon sups! t <br /> 2) NOMY THE LOCAL AGENCY OF ANY CHANGF-S TO TRIS INFORMATION WMFIN 39 DAYS OF TEM <br /> CHANGE <br /> OFFICE. <br /> County% Date Foxed: Date scauheFoxed: <br />