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Tank <br />Owner Statements 1 I' € 1 Operator <br />h'UST Requirements <br />and Understanding of and ComPfisuc.c wit <br />Facility*., <br />1�'acti�y I ,sem: <br />.. - s:d�isit or is term: <br />Addr0s, �' Ghatt�c of ik;stt;naled Operator <br />i acuity Phone 0, llpdtltcL'ottcatc f xPi,atlnn Nstc <br />nfisiGN A:m usrropu, .P.ATOR FOR THIS FACILITV'- <br />PATMARY ,.. <br />De5igmatoi upqrstor°x Nafr : <br />LY'LE D. NT.NMO <br />RU141143tii�iilgt�' <br />'AFF RDA`lkST <br />Designated Operator's Phonc lh <br />209 744.0112 <br />AL'TIFRNATE I <br />fycsi�+u�tcd npes;tt(re's lv(auc: <br />lie�VlA A. WINKLF:R <br />tusitm-, Name: <br />A 1•'f:ORDA-TEST <br />Durienuted Or:et•tttOr's t' UMC tF: <br />20 744-0112 <br />A! TERNATE a <br />Tksignatact 0peta1usr'6NaM' <br />Business NW' : <br />L Cr1? n$tt:d (J rat*r'S l'Itrl". M; <br />ALTERNATE 3 <br />( -iit rl�t(x1 U, L etnr'x NAanc: <br />IsWum% N arms: <br />fJc;sit'1cd c?pett9tar's P1wnc it <br />ZANF. A, IVii DA0 <br />AFV0RDA•T1;$T <br />207744.0)12 <br />FELIX G RAMWVZ <br />A,tIF )RDA=1'1:ST <br />204 744-0112 <br />ScrviccTechniciv <br />1CC # 52491 t 5AX <br />tix iration uatc: 7/t12009 <br />S(;rviac T�;hniciast <br />tcc4t 5263373-t1C <br />�ct'vi<c'I `w:luttiail4t� <br />tC;C'4 ,5263322 -UC <br />3110010 <br />Servicc: Technicial't <br />ILc 14 52731434.-U6 <br />I:opirveinw t'S4t' �%� 1!G(� t <br />1 Gertiiy 1.hat, fa: the tat'iltty inaiirritrd ut ti a to}. of this pain, ifu individuals listed aLxoVC will starve ass [lestgYtaivu t' <br />tUt t:►tors. '1'lse 'tlufi�: iduals3 will conduct and doctnnvilt nx►rttlily taciiiry juspectintis arid. asyl"W iitciiity ernployve trrur:in9 <br />aiccardanec with C'aldomia Code of RegialatiurYs, tike ,'-I, Rection 271 S W - (1). <br />Furthemore, I understund and aw is cot�►pl9ance w(tM ttio rcquiretnont�s (statVjcs, ation(s, and local <br />ordinances) uiyslivable to un"Wgniand *torage funks. <br />,SIGNATURK OF TANK 0WNEW <br />DATE -i <br />r / F <br />MR R RM <br />NUM: <br />I)St!Rmr!'THI`.5C()MlsLETFnFORMTOTHZIIXALAtii,NCY(�3'FSTAT W�A r RR-SOL)AiESL OhittOi BOARD) <br />AFrr,,R S(CNING TIT$: IAWALAGFJ4C: t' LIST ISAV,AILABLU AT: <br />1�1d7'!r`'7lu�loCALAt�F:NC1tC11»'AVYarHAIL[: '[u'fHISINFOP-MAIMONWITWIN YSOa'TiIrC:H�tNGF. <br />ED <br />� Ll+ <br />y <br />Td WHTb :2o Booz TZ •6nd Z9Zb9b6 60E: 'ON Xdd 92- J UM31UO N0 AOMS : WOdJ <br />