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X11 i a� L L- 416 2"d street Phone:(x.09)744-011 <br /> Galt,Ca 95632 Fax:(209)744-0116 <br /> afforda softcom.net <br /> Owner Statements of Designated XTuderground Storage Tank Operator . <br /> and Understanding of and Coan1 dance with UST Requirements <br /> Facility Name: VDD—Pac Pride Facility�: PO# <br /> Address: 351 N 13eekinen Rd Lodi CA 95240 UpdatedFfa B V ED <br /> Facffl 'bone#:209-944-911' [ cnWr re osu <br /> ' � L� New AeaCnstcQ Operator . <br /> pF <br /> IGP1fAT UST flPE A flR FORT IUSFA1�]L�'I�c'�. APR 4 7 2 Q 14 <br /> PRMARY ENVIRONMENTAL HEA41H <br /> Designated Vperator's Name: ZANf~NIMMO Service TechnimPARTM ENT <br /> Business Name: AFFORDA TEST ICC#: 5263322-i <br /> Designated Operator's Phone: 209-744-0112 Expiration Date; 3/3/16 <br /> ALTERNATE1 <br /> ]Designated Operator's Name: FT=RAMIREZ Service Technician <br /> Business Name: AFFORAA TEST ICC A 52733934-UC <br /> Designated operator's Phone; 209-744-4112. Expirations Bate: 313/16 <br /> ALTERNATE; <br /> Designated Operator's Name: DAVID ViDUMER Service Technician <br /> Business Name: AFFORDA TEST I,CC#: 5263373-UC <br /> Designated Operator's Phone: 249-744-0112 Exoratioan Date; 3/10/16 <br /> ALTERNATE$ <br /> Dedguated Operator's:Name: EDWARD STEARNS Service Technician <br /> Bnait:ess Name: AFFORDA TEST ICC#; 5250492-'U'C <br /> Designated.Operator's Phone: 209-744-01.12 Expiration Date: 3/3/16 <br /> " <br /> I terofy thea,for the fadllty iudicated at*e tap of this page,the iadivhivais listed above wi11 serve as Dated UStT <br /> Operators, The Individuals will cmduct and document monthly faciNty Inspections and anneal 1`0401ty employee <br /> trafnaiog,In <br /> Accordant*with California Cade of Regulations,title 23,section 2115(t)—(1). <br /> ForthermoM F understand and am in caml►llante with the requiremm U(statutes,regaiabous,and local <br /> Ordinances) applicable to underground storage tanks. <br /> NAME OF TANS 0WNER/i34erator(Print): <br /> SIGNATURE OF TANTS(yWNERC(7perator: , <br /> DATE. J41�04 OWNM PHONE: <br /> NOTE. <br /> 1) SUBMi7'TWT COWLITED FORM TO THE LOCAL AGENCY(NOT SWRCB)AMR STOM NO.THE LOCAL <br /> AGENCY LIST 15 AVAILABLE A7': www-wx&rbazr&c�¢ovlustlsOlt <br /> It CW 1•W� ' <br /> 2) NOTITY THE LOCAL AGENCY Op A1+y CHANGB,S'1`Q TM WORMATION WMFIN 30 DAYS OF TfM s <br /> CEIANGT4 <br /> County: J3:te Fried; 1"' "1 Date$caancdt Date FilVlailed 7 <br /> " <br />