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FACILITY NAME FACILITY PHONE <br />Manteca CO (209)239-0001 <br />FACILITY SITE ADDRESS CITY <br />430 W. Center Street Manteca <br />REASON FOR SUBMITTING THIS FORM (Check One): ❑ Change of Designated Operator ❑ Update of ICC Certification Expiration Date(s) <br />PRIMARY DESIGNATED UST OPERATOR FOR THIS FAC:II.ITV <br />Designated Operator's Name: Todd Hansen <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Service Technician 21 Third Party <br />Bussiness Name (If different from above): SaniVest Engineering Constructors, Inc. <br />Designated Operator's Phone #: (909) 594-9850 <br />International Code Council Certification #: 8045710 -UC <br />Expiration Date: 11/17/2011 <br />AL1r,1(t'%A1L' i MJV,31k31WkJLr, 7 U."91 U.rrIILAIUKJV A In1.911AU1.Lrlx (UP1101tal) <br />Designated Operator's Name: Relation to UST Facility (Check One) <br />Bussiness Name (Ifdifferent fi in above): ❑ Owner ❑ Operator ❑ Employee <br />Designated Operator's Phone #: ❑ Service Technician ❑ Third Pa <br />International Code Council Certification #: Expiration Date: <br />AL MCNA'i'U L VENLUINA'1 ED UST UPERATUR FUR THIS FACILITY (Optionat) <br />Designated Operator's Name: <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Service Technician ❑ Third Party <br />Bussiness Name (Ifdifferent from above): <br />Designated O erator's Phone #: <br />International Code Council Certification #: <br />Expiration Date: <br />