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UNDERGROUND STORAGE TANK SYSTEM <br />OWNER STATEMENTS OF DESIGNATED UST OPERATOR AND <br />UNDERSTANDING OF AND COMPLIANCE WITH UST REQUIREMENTS <br />For use by Unklocs Member Agencies or where approved by yow Local JuristdIction <br />I Authority Cited. 77de 23, Div. 3, Ch. 16 California Code offiegulations (CCP) I <br />!:AC!LrrY NAME FACILMY PHONE <br />---- Manteca CO (209)239-0251 <br />FACILnY STM ADDRESS CrTy <br />430 W. C*uter Street Manteca <br />1411 , ", # " I *, I j3VCql9VVA <br />lot, <br />OrT r"r, I <br />MCI <br />M -11M. <br />ALTERNATE I DESIGNATED UST OPERATOR FOR THIS FACILITY (00donal) <br />L! <br />UT=, M, �Rclation to 4ST FACMW fLleck lWe) Ls t t=. I <br />MMI[I Owner 0 Operator [I Employee <br />I P"M"T .1 r, . V i?.Or, M -M ",-1: M 0 W7. I =, � 17 10 Service Technician El Third Party <br />111IFFAZ <br />�ffltelation to UST Facility (Check On <br />�gg&, Qum M! �O Owner 0 Operator 0 Employee <br />�1'0 Service Technician Third Party <br />WVT7113 <br />I certify that, for the facility indicated at the top of this page, the ladlylilual(s) listed above will serve as Designated UST <br />Operator(s). The Individual(s) will conduct and document monthly facility inspections and annual facility employee training <br />In accordance with California Code of Regulations, Title 23, Section 2715(c) through (I). Furthermore, I understand and am <br />In compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. <br />Verizon Cautomit <br />�hsc. <br /># o , 4'. 1 511 1'a <br />77TTIM. 17ri IT _7 7T4N r4 xi <br />XXT319MIN 1T,"xr,7,7,xr7 am -.7i LmT�l <br /># <br />ITITR 7171111111110MV, 411V-79 <br />�ffltelation to UST Facility (Check On <br />�gg&, Qum M! �O Owner 0 Operator 0 Employee <br />�1'0 Service Technician Third Party <br />WVT7113 <br />I certify that, for the facility indicated at the top of this page, the ladlylilual(s) listed above will serve as Designated UST <br />Operator(s). The Individual(s) will conduct and document monthly facility inspections and annual facility employee training <br />In accordance with California Code of Regulations, Title 23, Section 2715(c) through (I). Furthermore, I understand and am <br />In compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. <br />Verizon Cautomit <br />�hsc. <br /># o , 4'. 1 511 1'a <br />77TTIM. 17ri IT _7 7T4N r4 xi <br />XXT319MIN 1T,"xr,7,7,xr7 am -.7i LmT�l <br />