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F <br /> Owner Statements of Designated Underground Storage Tank (UST) <br /> Operator and Understanding of and Compliance with UST requirements <br /> Facility Name: 7-ELEVEN SITE#32262 Facility ID#: 235423 <br /> Facility Address: 2360 W GRANTLTNE Reason for Submitting this Form(Check One) <br /> TRACY,CA 95376 ® Change of Designated Operator <br /> Facility Phone#: 209-830-9917 ❑ Update TCC#and/or Expiration Date <br /> Designated UST Operators)for this Facility <br /> PelmaO tional <br /> Designated Operator's Name: Christine Harris Relation to UST Facility(Check One) <br /> Business Name(Ifdifferent from above):Gilbarco Feeder Root ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: 925-206-5455 ❑ Service Technician ® Third-Party <br /> International Code Council Certification#: 5319944 UC Expiration Date: 9/27/2009 <br /> ALTERNATE I(Optional) <br /> Designated Operator's Name:SEE ATTACHED LIST Relation to UST Facility(Check One) <br /> Business Name(Ifdierent from above): ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: ❑ Service Technician 0 Third-Party , <br /> International Code Council Certification#: Expiration Date: <br /> ALTERNATE 2(Optional) <br /> Desi Operator's Name: SEE ATTACHED LIST Relation to UST Facility(Check One) <br /> Business Name(tfd fferent from above): ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: ❑ Service Technician ® Third Petty <br /> International Code Council Certification#: Expiration Date: <br /> I certify that, for the facility indicated at the top of this page,the individual(s)listed <br /> above will serve as Designated UST Operator(s). The individual(s)will conduct and <br /> document monthly facility inspections and annual facility employee training,in <br /> accordance with California Code of Regulations,title 23, section 2715(c)-(f). <br /> Furthermore,I understand and am in compliance with the requirements (statutes, <br /> regulations, and local ordinances)applicable to underground storage tanks. <br /> NAME OF TANK Q (Please Print): 7-Eleven Inc.—Ian Moorhead <br /> SIGNATUREOF TANK OWNER: <br /> DATE: 5127/2008 OWNER'S PHONE#: 91.6-463-6776 <br /> November 2004 <br />