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R E V E UNDERGROUND STORAGE TANK SYSTEM �`L'E"� 0 OWNER STATEMENTS OF DESIGNATED UST OPERATOR AND MAY 15 2 009 UNDERSTANDING OF AND COMPLIANCE WITH UST REQUIREMENTS For use by Unidocs Member Agencles or where approved by your Local Jurisdi"VIR ON MENT HEALTH Authority Cited: Title 23, Div. 3, Ch. 16 California Code of Regulations (CCR) PER IT/SE VICE FACILITY NAME FACILITY PHONE Manteca CO (209)239-0251 FACILITY SITE ADDRESS CITY 430 W. Center Street Manteca REASON FOR SUBMM INO THIS FORM (Check One): 21 Change of Designated Operator ❑,, Update of ICC Certification Expiration Date(s) PRTMARV DESIGNATED UST OPERATOR FOR THIS FAC:H TTV Designated Operator's Name: Philip De Forge Relation to UST Facility (Check One) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician 21 Third P Bussiness Name (Ifdifferent from above): SunWest Engineering Constructors, Inc. Designated Operator's Phone #: 909 594-9850 International Code Council Certification #: 8012415 -UC Expiration Date: 6/27/2010 ALTERNATE 1 DESIGNATED UST OPERATOR FOR THIS FACILITY (Optional) Designated Operator's Name: Leonardo A uilar Relation to UST Facility (Check One) Bussiness Name (Ifdifferentfrom above): SunWest Engineering Constructors, Inc. ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone #: (909) 594-9850 ❑ Service Technician Q Third Party International Code Council Certification #: 5302718 -UC Ex iration Date: 2/3/2011 ALTERNATE 2 DESIGNATED UST OPERATOR FOR THIS FACILITY (Optional) Designated Operator's Name: Luls Navarro Relation to UST Facility (Check One) Bussiness Name (Ifdierentfiom above): SunWest Engineering Constructors, Inc. ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone #: (909 594-9850 ❑ Service Technician 0 Third Party International Code Council Certification #: 5262210 -UC Expiration Date: 4/10/2011 ALTERNATE 3 DESIGNATED UST OPERATOR FOR THIS FACILITY (Optional) Designated Operator's Name: Rud Almazan Relation to UST Facility (Check One) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician R Third Party Bussiness Name (Ifdifferentfrom above): SunWest Engineering Constructors, Inc. Designated Operator's Phone #: (909) 594-9850 International Code Council Certification #: 5256842 -UC Expiration Date: 4/10/2011 I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training in accordance with California Code of Regulations, Title 23, Section 2715(c) through (t). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. TANK OWNER NAME: Verizon California, Inc. sUN.• k/► TANK OWNER SIGNATURE: OWNER PHONE: (909) 620-5962 t�F74VM 1. Report the name(s) of the Designated UST Operator(s) as registered with the International Code Council (ICC). ICC certification information is available on-line at: www.icesfife.org/e/certsearch.html. Search for "California UST System Operators" 2. Submit this completed form to the local agency that regulates this facility's USTs. Unidocs member agency jurisdictions and contact information are listed on-line at:,vvww.unidoes.org/members/Whoregulateswhat.htmi. Contact information for other local agencies within California is available at: www.swrcb.co.gov/cwphome/ust/contacts/docs/iocal_agency_list.xls. 3. 23 CCR §2715(a) requires that you notify the local agency of any changes to this information within 30 days of the date of change. UN -062 - 1/1 www.unidocs.org 9/22/2005