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RECEIVED UNDERGROUND STORAGE TANK SYSTEM OWNER STATEMENTS OF DESIGNATED UST OPERATOR AND A U fj 0 6 2 013 UNDERSTANDING OF AND COMPIJANCE WITH UST REQUIREMENTS For use by Unidocs Member Agencies or where approved by your Local Jza*dfiNV1 R 0 N M E N TA L Authority Cited:Title 23,Div.3, Ch.16 California Code of Regulations(CCR)HEALTH DEPARTMENT FACILITY NAME FACILITY PHONE Manteca CO (20912..39 - 0001 FACILITY SITE ADDRESS CITY 430 W.Center Street Manteca REASON FOR SUB THIS FORM(Check Ow): Change of Operator Update of ICC Certification Expiration Date(s) PRIMARY DESIGNATED UST OPERATOR FOR THIS FACILITY Designated Operator's Name: Paul McLane Relation to UST Facility(Check One) Bussiness Name( di stent above): SunWest Engineering Constructor.%Inc. [I Owner 0 Operator D Employee Designated 02cratoes Phone#: (909)594-9850 El Service Technician 2 Third International Code Council Certification#: ?17��;7?- UC— Expiration Date: 1/24/2015 ALTERNATE 1 DESIGNATED UST OPERATOR FOR THIS FACILITY(Optional) 22siEated Operator's Name: Leonardo Aguilar -Relation to UST Facility(Check One) Bussiness Name Lf different from above): SunWest En Leering Constructors,Inc. El Owner 0 Operator El Employee Desi ted OEE!tLr's Phone 0: ft09 )594-9850 0 Service Technician PI Third Party_ International Code Council Certification#- 5302718-UCEMn�-_ation Date: 1t23/2015 ALTERNATE 2 DESIGNATED UST OPERATOR FOR TIM FACILITY(Optional) Desig2ated 02smior's Name: Ruben Beeerra 'Relation to UST Facility(Check One) Bussiness Name(If different from above): SunWest Enj!!cerin g Constructors,Inc. 0 owner El operator El Employee Des!gnated 2Lwatofs Phone#: (909)594-9850 F1 Service Technician R1 Third International Code Council Certification#: SM7833-UC Expiration Date: 1t23/2015 ALTERNATE 3 DESIGNATED UST OPERATOR FOR TIUS FACILITY(Optional) Desi ted 2perator's Name: Pamela Lawrence Relation to UST Facility(Check One) Bussiness Name ff!A�t am above): sunwest Engines Constructors,Inc. El owner 0 Operator n Employee Desi ted Operator's Phone#: (909)594-9850 El service Technician R Third Laq International Code Council Certification#: 8078357-UC Expiration Date: 91Q2814 I certify that,for the facility indicated at the top of this page,the individuaks)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,Se 'on 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. TANK OWNER TITLE: Environment Managemea OWNER PHONE: (909)620-5%2 TANK OWNER SIGNATURE: DATE: r_xhh cA INSTRUCTIONS 1.Report the name(s)of the Design ed UST Operator(s)as registered with the International Code Council(ICC).ICC certification information is available on-line at www.icesafe.org/e/certsearch.htmi.Search fhr"California UST System Operators." 2.Submit this completed form to the local agency that regulates this facility's USTs.Unidoes member agency jurisdictions and contact information are listed on-line at vn"v.uimidomarg/members/whoreplateswhathtmi.Contact information for other local agencies within California is available at:www.s-tvreb.ca.gov/ewphowelast/coiltacts/doemocaLagency -jw XIL 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.unidoes.org 9/22t2005