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Mar 28 12 03.27p Reliable PetroleumA 209-845.8953 p.6 <br /> i <br /> Ownq, Ig0MViltsofTlfsiynatodUn�ai5t lante(U51)Operator <br /> d Undersmnd a cf aild Cot VhVkTIvc With UST Requirements <br /> F¢rilirtM¢mwO `>%AY4tcON —' .— <br /> i �.1, .t11._ c.�on�A 95N fAhlililli4___ <br /> 5 S"W Clwfiet wt-St¢ . J6 Rtaeron for&ktaildng this Form jCheck One) <br /> rfnlilin'Phonet,':1 1946T3 x0 �,,,,'I ❑ ChanycifDrspateoQPvAror <br /> —. IX Update Ceffficalc&ryiacion Date <br /> Designated UST Operator(s) for this Facility <br /> �PA1824RY —' <br /> S Imm u ar .--- <br /> �fl P 'a Pleat..AvLc.t amnhzrt - _^Tjejalion m LIST encirry lt76ccp One, <br /> Rutiness'vame{!% J?venrJitvn aioreJ.iteliah'e°erro!eunt Senxar Inc. <br /> e Owner ❑ Uperat¢r Q Emproym <br /> Uesi¢rute<I Opvm '$Phone34n - <br /> GO.t•9336 X Sa'vian Teuhreea¢ L Third'PMrV <br /> Interner'orel Cotic a.mal 1; i-n A:9;tZ5gp-t1C <br /> _ Ex._piraticn DOW.011'2&?061 <br /> ACTEANnl'C+7 I ''So,:WJ _ __ <br /> • :MilIInxaf Upamia jx)lc..,..0...,;d�yo Sare,a:c . <br /> d <br /> m! Nmei .nfam cilput�; — AelatiDnwllS'r Fattili ((.Aoe•6.?nej ' <br /> 7 O Otcutt Q 09tmlar O r:mplo><c•IP12ted Opaato s[•bone 9;209.504.9363 tc <br /> Cp,n.c'ra:6uidyry � JmM.Nar!)_ <br /> l mlm^ hmhl I"r.1r �,ructl(:�nlTl.at.a, 7!3WlI•VV —_— <br /> ha --i q�• __ <br /> 'if�lirdRoln'f�lr R!'f}fi <br /> n,.a,LKlnA'I L:a ( 'tiv,eu!) <br /> D1PIii"nMMI(1pr17Mi "iuunn ii4�n <br /> —� _ III'bIIINI IIID IaI lnnnq U"5..t 13..J <br /> ;'A me(/f1 rtnwjimv,sb,wtl _-'_— ❑Owner <br /> O opeator 0 tmpkn , <br /> D ,igaxad opaatc. 'Plwrv;Y; ' <br /> ❑ Service Tmhnician Q Y7,iiypan�• <br /> lftrtnatinnrJ Crde rJ Ctilificxdon, _ expiration Dale <br /> I certify that, fo the facil ity indicated at the top of this page,the inditittual(x)listed above will <br /> settle as Designcd UST 0pe=j(s), The individuals),mill conduct and documcnt ma„a,l; <br /> tilCilitYiMsPe,06 s and armual€aeiUEy etrployee tiaiPag,in accordance with Califomia Code of <br /> Regulations, till 23,scetion 2715(c)-(1). <br /> I Furthermore,I inderstand and am in compliance with the requirements (statutes, <br /> rtY1d�tig3tS, an Melt nrdinoneea)APA.ubicfoundexgieuudstorage Tanks. <br /> i <br /> NAMP OrTANK I IWNCR(MeasePrinp.. <br /> AM III l Intl III 11'9Y (WIN1•I11 in Or 1L1 i�1 i" <br /> OWNER'S PHONE d: <br /> NOTE: I)SUBM'l 'H1SCOn•IPL8TBD5.OR;MTOT14CLOCALACENCY(NOT TuE.;sr.irtiWATER <br /> RESOURIU S CO AOL BOARD)BY JANUARY 1.205.THE LOCAL AGENCY LIST 1S nYAILARLE <br /> AT: ._LX;Dti;VL;j-0CacLsrCUna a_n'c htrnl. <br /> 2)NOTIFY THE A L AGENCY OF ANY CHANGES TO THfS INFORMATION WITHIN J0 DAYS <br /> OF THE CHA.NC <br /> Vot"ember 2004 <br />