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Appendix Underground Sto al Designated IUST p ge7'ank TYPE OF ACTION Operator Identification Form ❑ New UST Installation 1. FACILITY INFORMATION ® New/Changed Designated Operator CERS ID _ 10186995 Facility Name I Facility dre Address— M F ARCH & BIANCHI 76 1916 MARCH LANE City 2. DESIGNATED UST OpE STOCKTON ZIP Code _-_ OPERATOR INFORMATION `�"'� -- 93210 Print names exact/- y as Shown on the ICC certification. Name of Designated UST O - perator Nik Zac,�orov ICC Certification Mailing Address —= 5264361 PO Box 1394, Laf_a rette, CA 94549 Phone - Name of Designated UST O p re a of r 888-500-2435 Marco Alejos --- ICC Certification Mailing Address 8415074 PO Box 1394, Lafayette, CA 94549 Phone Name of Designated UST Operator --- --- --____ 888-500-2435 _ Zane Nimmo —_ _ ICC fica Certition Mailing Address ------------- _ 8883064-UC PO Box 1394 Lafayette, CA 94549 Phone Name of Designated UST Operator 888-600-2435 Felix Ramirez ICC Certification_ Mailing Address 8883072-UC PO Box 1394, Lafayette, CA 94549 Phone Name of Designated UST Operator 888-500-2435 Edward Stearns ICC Certification Mailing Address I 8883080-UC PO Box 139A Lafayette, CA 94549 Phone 888-500-2435 !Name of Designated UST Operator Erik Hinc josa ICC Certification Mailing Address 9209377 PO Box 1394, Lafayette, CA 94549 Phone Name of Designated UST Operator - ---- ----- 888_500-2435 Yolanda Thruston ICC Certification Mailing Address 8163784 PO Box 1394, L Phoneafayette, CA 94549 Phone 0-2435 Name of Designated UST Operator ICC Certification Ian Hall 5311539-UC Mailing Address Phone PO Box 1394, Lafayette, CA 94549 888-500-2435 Name of Designated UST Operator ICC Certification Rafael Armas _ _ 10677162 Mailing Address Phone PO Box 1394, Lafayette, CA 94549 - _ - 888-500-2435 CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council, UST = Underground Storage Tank Page 1 of 1