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E <br />FACILITY NAME FACILITY PHONE <br />Manteca CO ( 2 0 9 ) 2 3 9 - 0 0 0 1 <br />FACTLITY SM ADDRESS CITY <br />430 W. Center Street Manteca <br />,REASON FOR SUB NG THIS FORM (Check ate): El Change of Designated Operator El Update of ICC Certification Expiration Dates) <br />DesignatedOperatoes Name: Todd Hansen <br />Relation to UST Facility (Check One) <br />Bussiness Name (If differentfrontabove): SunWest Engineering Consfivetors, Inc. <br />0 Owner El Operator El Employee <br />Designated Operator's Phone #: (909) 594-9850 <br />LJ Service Technician 2 Third Party <br />International Code Council Certification #: 8045710 -UC <br />ExEirationDate: 11/17/2011 <br />ALTERNATE I DESIGNATED USTUrEKAXVK FUR THIS YAUMfl-Y (UP11OUal) <br />Desi hated OE2,toes Name: Relation to UST Facility (Check One) <br />Bussiness Name (If differeniftom above): n Owner 0 Operator [I Employee <br />Designated Operator's Phone #: El Service Technician Third P� <br />International Code Council Certification Expiration Date: <br />A ii.TFUN Ar'P. 7. nPRIGNATUM TILT nPVR ATOR Pon THIS FACILITY tOnfinual) <br />Designated Operator's Name: <br />Bussiness Name (If differentfi-om above): <br />k) <br />/ <br />Relation to UST Facility (Check One) <br />[:1 Owner 0 Operator [I Employee <br />El Service Technician ❑ Third Parly <br />Designated Operator's Phone #: <br />International Code Council Certification #: <br />Expiration Date: <br />lir ?, 6 - Q C) <br />