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DEC 18 2020 <br /> ENVIRONMENTAL HEALTH <br /> UNDERGROUND STORAGE TANK PERMITISERVICES <br /> OWNER ,( OPERATOR AGREEMENT <br /> OPERATOR: <br /> As operator of the underground storage tan <br /> ks,I hereby certify tat I monitoring and reporting requirements contained in Title 23, fthe California the <br /> of Regulations and I have received a copy of Section 25299,Chapter 6.7,of the Code <br /> California Health and Safety Code. <br /> SIGNATURE: <br /> ]�i� i DATE:_) 7`-0Y <br /> f () <br /> DBA NAME: <br /> OPERATOR NAME: <br /> LOCATION: <br /> i <br /> l' <br /> c--:Yr nm j <br /> OWNER: <br /> As the owner of the underground storage tanks,I, rZ certify <br /> that �a�. U�r I? has been provided a co (OWNER'S NAME) <br /> (OPERATOR'S NAME) py of the monitoring and <br /> reporting requirements contained in Title 23,of the California Code of Regulations. <br /> %I' I also certify that <br /> (OWNER'S NAME) 'r °'~p— V?,9P2 has been <br /> provided a copy of the penalties for noncomplia cepERATORas specified in Se)ction 25299, <br /> chapter 6.7,of the California Health and Safety Code. <br /> SIGNATURE•��—LDATE:--J" <br /> 7/5/97 <br />