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Owner Statements of Designated Underground Storage Tank (UST) Operator <br /> and Understanding of Compliance with UST Requirements <br /> Designated UST ODerator(s) for this Facility <br /> Facility Name:FedEx Ground Facility ID#:953 <br /> Facility Address: 5655 Hood Way Reason ibr Submitting this Form(Check One) <br /> Tracy,CA 95377 ' Change of Designated Operator <br /> Facility Phone:209-839-2000 ❑ Update Certificate Expiration Date <br /> PRIMARY <br /> Designated Operator's Name:David Turner Relation to UST Facility(Check One) <br /> Business Name(1fdi,(/erentfromabove):Franzen-Hill Inc. ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:(559)688-2977 ' Service Technician ❑ Third-Party <br /> International Code Council Certification#:8788650UC I Expiration Date:9/8/18 <br /> ALTERNATE 1(Optional) <br /> Designated Operator's Name: Relation to UST Facility(Check One) <br /> Business Name(If dierent from above): : ,� caner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: tom, ❑S ice"1"echnician 0"1"hird-Party <br /> L <br /> F3 I ctlov <br /> International Code Council Certification#: Expiration Date: <br /> ALTERNATE 2(Optional) <br /> Designated Operator's Name: Relation to UST Facility(Check One) <br /> Business Name Q(diifferent from above): ENVIREAMENTAt" r !�, wrier 13 Operator ❑ Employee <br /> Designated Operator's Phone#: ` ervice Technician ❑Third-Party <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 above will <br /> serve as Designated UST Operator(s). The individual(s)will conduct and document monthly <br /> facility inspections and annual facility employee training, in accordance with California Code of <br /> 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 OWNER(Please Print): rix lei <br /> SIGNATURE OF TANK OWNER: <br /> DATE: / OWNER'S PHONE#: y(� <br /> NOTE: l)SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY(NOT THE STATE WATER <br /> RESOURCES CONTROL BOARD)BY JANUARY 1,2005.THE LOCAL AGENCY LIST IS AVAILABLE <br /> AT: www.w4tcrboar6-.ca.g2v/usucontactsicu124 ggvs.html. <br /> 2)NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS <br /> OF THE CHANGE. <br /> November 2004 <br />