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244 West Harding Way PR0231137 <br /> August 2, 2021 Program: UST <br /> PHOTO 1: U dated DO ID form not uploaded to CERS. <br /> Appendix XI <br /> Underground Storage Tank <br /> Designated UST Operator Identification Form <br /> TYPE OF ACTION ❑New UST Installation <br /> - El New/Changed Designated Operator <br /> 1. FACILITY <br /> CERS ID INFORMATION ____ <br /> 10180779 Facility Name <br /> Facility Address MIRACLE MILE <br /> 244 E HA DING WAYCity P <br /> �rwnl UN _ Vc�Rp <br /> 2. DESIGNATED PER <br /> USTOIR III I aAT1ON `R !95204 <br /> Arn <br /> rnnr names exactly as shown on the ICC certfiC i n <br /> Name of Designated UST Operator <br /> David Winkler ICC Certification <br /> Mailing Address 8883059-UC <br /> 416 2nd Street Gait,CA 95632 Phone <br /> Name of Designated UST Operator 209-744-0112 <br /> Zane Nimmo ICC Certification <br /> Mailing Address ----" 8883064-UC <br /> 416 2nd Street Galt,CA 95632 Phone <br /> Name of Designated UST Operator 209-744-0112 <br /> Felix Ramirez ICC Certification <br /> Mailing Address 8883072-UC <br /> 416 2nd Street Galt,CA 95632 Phone — <br /> Name of Designated UST Operator 209-744-0112 <br /> Edward Steams ICC Certification <br /> Mailing Address 8883080-UC <br /> 416 2nd Street Gait,CA 95632 Phone <br /> Name of Designated UST Operator 209-744-0112 <br /> Amy Winkler ICC Certification <br /> Mailing Address 9951352-UC <br /> 416 2nd Street Galt,CA 95632 Phone <br /> Name of Designated UST Operator 209-712-0112 <br /> ICC Certification <br /> Mailing Address Phone <br /> Name of Designated UST Opc.ratorICC Certification <br /> Mailing Address Phone <br /> Name of Designated UST Operator ]CC Certification <br /> Mailing Address Phone <br /> Additional copies of this page may be attached. <br /> • <br /> CERS=California Environmental Reporting System,ID=Identification,ICC=International Code <br /> Council,UST=Underground Storage Tank <br /> Page 1 of 1 <br /> Lydia Baker, SR. REHS Page 1 of 1 <br />