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May 10,11 04:49p Reliable PetroleumA 209-845-8953 p.4 <br /> I <br /> i - <br /> Owner aternents Of Designated Underground Storage Tank(UST) Operator <br /> Unde rstaading of and Complianoe with UST Requirements <br /> Facility Nam: 082602 r iliJy tD : <br /> Fatarlity Ad&css 43()Joe Pombo Parkway,Trseev CA gg?,d Recon`a Submitting this Form(Chaak Oae% <br /> Change of Designated Operator <br /> Facility Phgrre Q4-8s30.S?74 X [:pdate Certificate Ex9irstion Daw <br /> Designated PST Ouerator sir t#sJis Facility <br /> PRIMARY <br /> Design"Op r?�Unv: Robert Barnhtx! lteletion w UST?acuity(Check One) <br /> ButsinmName( t�ereretJin.n�botir}:ReJSabteFerroleerrServi:es/rc D %vrm 13 Qpesanor O Emptoyn <br /> Designated 01mr 's Phone n: 20%604-7336 X Service l sxhniciiar, 0 Thi td-Carty <br /> IncrrtatipnatCo oundJ CatiSioatiorto. «zS25e0-UC F-Vimrtivn Dole: .223 2011 <br /> ALTERNATE T <br /> Designated Opera 's Name:Gtatupo sancz Rchttian to'JST raoil ilr(Chec!c Qrtrp <br /> Business Nstne(d "'eMOW�`rara nriova):Retitrble PePmte+ern Serrlcer ham. <br /> a Owner t7 (?Pastor C3 Eagloyee <br /> Desigt�tedQprra �Phonc :2Q9.tip4-8363 X jerr=Tochniaan :1 Thud-Pnrny <br /> ratMTA4i0n0t wartotl Certifieadoa k:32JO451-t.'C ExplMdou Date:01.ZX2,313 <br /> ALTERNATE2 >a41) <br /> F9U=&inCSSx%:aM=TAft0 <br /> T .S Nanto. Relation to U&I,Facuily i Glreek Qm� <br /> (if zrrm from above): <br /> 0 t3vmer 0 Qpenta D lEtnptopes <br /> t1CsiRnatndt)petat Phone#-. C �eniceT.xh�ioian 3 Third-party <br /> tR-10 mGtlonal Code oundi Ccrtiricatiwt#: Expiration pate <br /> I oertify that, the facility indicated at the top of this gage; the individual(s)listed above Will <br /> serve as D si ted UST Operator(s). ;lie individual(s)will conduct and doctaJittent tnattihly <br /> facility iJns a ns and annual facility errmplayee training, its accvrdence with California Code of <br /> Regulations, ti 23; section 2715(c) - (!�, <br /> Furthermore, understand and am in compliance with the requirements (statures, <br /> regulations,al focal ordiNaJnces)applicable to underground storage tanks. <br /> NAME OF TANJ OWNER{lteasePrint): <br /> SIGNATURE O ANKOWNER: riE , <br /> DATE.- O.WNERIS PHONE <br /> #: <br /> NOTE: 1)SUB 1K TKIS COMPLETED FORM TO THS LOCAL,AGENCY(NOT THE STATE WATER <br /> RESOURCES C TROL BOARD)BY JANUARY 3,2005.THE <br /> AT: w • . LOCAL AGENCY LIST!S AVAILABLE <br /> vratcaw"u-tic noel cu t: a��w.i:tml. <br /> 2)NOTIFY THE CAL AGENCY OFANY CHANGIES TO THIS INFORMATION WjTFfjN.30 DAYS <br /> OF THE C14., <br /> November 2004 <br />