Laserfiche WebLink
Appendix XI <br /> Underground Storage Tank <br /> Designated UST Operator Identification Form <br /> TYPE OF ACTION ❑ New UST Installation Ox New/Changed Designated Operator <br /> 1 . FACILITY INFORMATION <br /> CERS ID Facility Name <br /> 10181387 Ryder Truck - Stockton <br /> Facility Address City ZIP Code <br /> 3633 Duck Creek Drive Stockton 195215 <br /> 2 . DESIGNATED UST OPERATOR INFORMATION <br /> Print names exactly as shown on the / CC certification. <br /> 1:1 0MI GPM <br /> Name of Designated UST Operator ICC Certification <br /> James Keltner 8178558 - UC <br /> Mailing Address Phone <br /> 930 Ames Avenue , Milpitas , CA 95035 (408) 942 -8686 <br /> Name of Designated UST Operator ICC Certification <br /> James Ruble 8319128 -UC <br /> Mailing Address Phone <br /> 930 Ames Avenue , Milpitas , CA 95035 (408) 942-8686 <br /> Name of Designated UST Operator ICC Certification <br /> Rolando Urbina 8009631 -UC <br /> Mailing Address Phone <br /> 930 Ames Avenue , Milpitas , CA 95035 (408) 942 -8686 <br /> Name of Designated UST Operator ICC Certification <br /> E <br /> dress Phone <br /> esignated UST Operator ICC Certification <br /> Mailing Address Phone <br /> Name of Designated UST Operator ICC Certification <br /> Mailing Address Phone <br /> Name of Designated UST Operator ICC Certification <br /> Mailing Address Phone <br /> Name of Designated UST Operator ICC Certification <br /> Mailing Address _ Phone <br /> Additional copies of this page may be attached. <br /> CERS = California Environmental Reporting System , ID = Identification , ICC = International Code <br /> Council , UST = Underground Storage Tank <br /> UW062 www. unidoes .org Rev. 10/0U20 Page 1 of 1 <br />