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Mar 28.12 03:29p Reliable Petrole 20 -845-8953 p.12 _ I I i Owner ements of Designated Undergrourtd Store'Wank(UST) Operator Understanding of and Compliance with UST Requirements Facility Name: 'R tJ AJui PM 082642 Facility tD#f: Facility mit 430]cePo�bo F3rkwa}> t'racy CA 953,6 Reason for SWmdrdng this form heck one) D Ckanrse of I?esgnatcd Operasor Facility PbunerG j2 4x330-g770 X update Certificate 8xpiation Cale i ; Desiggated UST(3 ple'atuil+[sl for this Fxcil,ity PRi14[ARY Jasi gtttded O 's A'a-te.ttabert Swnhan aBxpirtfion ST Faciliry(Check one) in=.latttc( WAWA obmq):Reliable Petroleum Service,Lw C OPetztor Q Employ" Dcaipat ed Op ct; s Mum 4:209-6"9336 =4 acian C Thi d.pany Eniereatiortal C ' sl C. kation 1►:=252540-UC ces 01+28i201 0 ALTEINATE I is DCtignat (*e ' s Nw tc:Guadalupe 5anater halation to UST Fttcitky(Check Quer i3usinessNamc a60v0-Rrt&la Perroterm Services be. O Ownrx O Operator tJ Employ= Desigrta�dOpe `sPhune :2G9-60•i-9363 X SaviccTachnician 0 Third-Marty intcmad mai Cod` ountal Certit5entioa q:325a43I_UC Eospir�ion Date:al,'3}l24!3 ALI RNATE 2 '� llaralj D�gaatcd O s Name: Ra1'i',to UST Facility(Ckeck 0� Business Nesse(_' erarrrfrorz ebr�- Designated O i s Phone g; O Owfler t3 Oporator CJ Bttyslonee Ea Sa�iceTmftriw D Third paM ittlGmtttiSflttF l lr tifcalion:: QCPiMODU Data r Cern£Y theta the facility indicated at the to of this serveP page..the indi vid%-W(s)listed abode wilof acifi as Desi ' ted UST Operator(s). The indi;,idual(s)wilt conduct and document monthly facility insIn ns and annual facility employee trak&,g in accordance utith California Cadeegu taiotts t' 23,section "2715(c)_(f), Furthermore,i tutderstand and am in CGUI lliance with the requirements (statut:cs,, �re;tllatitouas, local ordinances)applicable to underground storage tanks. NAME OF TAN' OWNER(Please priint):_ 7E-C- 7 �'/�.) 4.41 SIGNATURE O , ANK OWNER: DATE: NOTE: I}SUBM TU S C014PLETED FORM TO THE LOCAL AGENCY(PLOT THE STATE WATER RESOURCES C OL BOARD)By JANUARY 1,2005.THE LOCAL ACrENICY LWT TS AYAILAOLE AT: tx�.rw.water >ovlt►st;eo u a vs htrall. .'.)Elr4?TIFY THE CAL AGENCY OF ANY CHANCES TO THIS I'VID"IATION WITNIP430 DAYS OF THE CHAN November-2004 ;