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Jul 22 08 12: 29p sjmc mount dept 209 461 7 <br /> - 1 ,(J.� <br /> Owner Statements of Designated Underground Storage T ankQperator ' <br /> and Understanding of and Compliance with UST Requisrremei t02008 <br /> racif)fy Name: ST - oSEkFN 'rrf t'nciBlyu: N NVIP At OUNTy <br /> � !< <br /> Addren: Kenson 1'or this f-01 in HKT4 evT <br /> S7KEE El Change of Designated OperMor <br /> I'trcility Ptwne#: Obi ■ Update Cerli(+cale O pnotinn Date <br /> 09� 3- <br /> DESIGNATED UST OPERATOR FOR THIS FACII ATY: <br /> PRIMARV <br /> Designated Opo OWN Name: LVLT 0.NIMMO Service Technician <br /> 8LIni11CN,Name: AFFORUA•TM F IC'C11 5249115-1)C <br /> Uesignmed0 eratot'sPhnneN: 209744-0112 Expirata+nLMtc: 7/1/2009 <br /> ALTERNATE 1 <br /> ElLsiRnaied Operator's Nnme: DAVID A. WINKLER Service Technician <br /> BilmnessName: AFFORDA=rFS'I' IC'Cit 5263373•I)C <br /> rh5ignawd Up..rlc 's Phone ff: 'M)744-0112 Lxinnitionoati 3/ <br /> AUFF..RNATE 2 -- <br /> Ucsignateclopem(or'.Name ZANE A. NIMMO Service Technician <br /> Rusinese Name: AFFOKDA-IF.ST IC'C R 5263322-CIC <br /> Designated Operator's Phone M 209744-0112 Expiration Dais 3/142010 <br /> AUI'ERNATE 3 <br /> Designafcdoperntor'sNamc'. FFLIX G RAMIREZ Servicelechnician <br /> Rosiness Narver AFhOKDA-I F$T ICC It 52731 <br /> Destgnsted Operator's Phone It 209 744.0112 jixpini 6/2f/2010 <br /> I Cel that, Rn'rhe facility indicnsrd at Ilse tap of this page,the hulividunls listed above will serve as besignaced UST <br /> Opernlnrs. l be individuals will conduct and docamcnt munlh)y f cility inspections anti annual facility employee trtuniot;,in <br /> accordance with C'aliRumia Code or Regulations,title 23,section 2715(c)-(1). <br /> Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local <br /> ordinances) applicable its underground storage tanks. �f <br /> NAME OK TANK OWNER (Print): �Y� ' 7;—f - ---- <br /> SIGNAL URE OF TANK OWNER: c &� — — /—' —` <br /> DATE: %— d OWNER'sPHONE: rf7- 7//-6918 <br /> WOE: <br /> 1)SURMIT Ts IIS COMPLETEn FORM'FO THE 1.(WAI.AGENCV(NUTSTAI'E WAT'LR RESOURC-LS C.ON'1'ROL BOARD) <br /> AFTERRIGNINGTHF.T.00ALAGENCV LISLLSAVAII.AULCAT: wvw.wltle& omds.ra.g Yn A(st/ar,maarslc i a• .lehrll: <br /> 2)N07'IFYTHELOCALACr.NCYOFANYC'HANGLS'1'OTIIISINPWtMATION WflifIN300AYSOI-THE(-HANIa?. <br />