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02/20/2008 15: 04 70767(38111 ALPHA PETROLEUM PAGE 03/03 UNDERGROUND STORAGE TANK SYSTEM OWNER STATEMF,NTS OF.DESIGNATED UST OPERATOR AND UNDERSTANDING OF AND COMPLIANCE WITH UST REQUIREMENTS For use b),Unidocs A'lember Agenclev or where approved by your Local Jurisdiction Authority Cited: Title 23. Div. 3,Ch, 16 California Code ofRagtduNons(CCR) FACILITY NAME FACILITY PIIONE Valero #3698 (209)832-8815 FACILITY SITE ADDR85S CITY 153 East 11th Street Tracy, Ca REASON FOR SU0M1TnNGTHf5 FORM(Chrek Orr): Changeof Doigmued Operator UpdalcoflCCCertifiewim Expiration Dates) PRIMARY DESIGNATED UST OPERATOR FOR THIS FACILITY DESIGNATED OPERATOR NAME: Larry Williams RELATION TO UST FACILITY(CheckOrr) BUSINESSNAMEIlfdiffemnrfromubn,e): Alpha Petroleum Services, Inc. ❑ Ch%=r ❑ Operator ❑ Cmploycc DESIGNATED OPERATOR PHONE: (707)678-8100 ext ® "Vice Technician ❑ Third-Party INTERNATIONAL CODE.COl1NCIL CCRTIFICAnON NO.; 5242370-UC EXPIRATION DATE. 8/26/2008 ALTERNATE I DESIGNATED UST OPERATOR FOR THIS FACILITY ri_onal DESIGNATED OPERATOR NAME' John Palest REIATION TO UST FACI UTY(Chrek Orr) BUSINESS NAME(ffdifferenrfram ahmr): Alpha Petroleum Services, Inc ❑ Owner ❑ Operator ❑ Employe DESIGNATED OPERATOR PHONE: (707)678-8100 ext. ® Service Technician ❑ Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATIONNO,: 52559473-UC EXPIRATION DATE: 10/18/2009 ALTERNATE 2 DESIGNATED UST OPERATOR FOR THIS FACILITY(Optional) DESIGNATED OPERATOR NAME: RELATION TO UST FACILITY(Cheek One) BUSINESS NAME(ffd*mnifi abmv): ❑ O%mcr ❑ Operator ❑ Employee DESIGNATEDOPERATORNIONE: ( ) ext ❑ ServiceTechnician ❑ Third-Pany INTERNATIONAL CODE COUNCIL Cid RTIFICATION NO.: EXPIRATION DATE ALTERNATE 3 DESIGNATED UST OPERATOR FOR THIS FACILITY(Optional) DESIGNATED OPERATOR NAME: RELATION TO UST FACILITY(Check One) BUSINESS NAME(Ifdij&nntfro abmv)I ❑ Owner ❑ Openuor ❑ Employee DESIGNATED OPERATOR PHONE: ( ) ext ❑ Sm'icc Technician ❑ Third-Prrty INTERNATIONAL CODE COUNCIL CERTIFICATION NO,: EXPIRATION DATE: I certify that, for the facility indicated at the top of this page, the iadividual(s) listed above will sen•e as Designated UST Operatnr(s). The Iadividual(s)will conduct and document monthly facility inspections and annual facility employee training in accordance with California Code of Regulations, Title 23,Stelion 2715(5) through (f). Furthermore, I ondersland and am in compliance with the requirements(statutes,regulations,and local ordinances)applicable to underground storage tanks. TANKOWNERNAME: Valero TANKOWNERTITLE: Sandy Huff, Compliance Coordinator OWNERPHONE: (559)582-0241 TANK OWNER SIGNATURE: DATE: February 14, 2008 INSjRUCT10N5 I. Repot the name(s)of the Designated UST Opernar(s)as registered with the International Code Council(ICC). ICC certification information is available on-line at:www,iccsafe.org/eleertscarch.litrrtl.Search for"California UST System Operators." 2. Submit this completed form to the local agency that regulates this facility's USTs. Unidocs member agency jurisdictions and contact information are listed on-line at: www.unidocs.nrg/members/whoregulateswhat.html Contact information for other local agencies within California is available at:wwwswreb.ca.gov/Cwpilome/ust/conincisiducstio"a—Agency_list,xls. 3. 23 CCR§2715(a)requires that you notify the local agency of any changes to this information within 30 days of the date of change. Il\-0hd-1/I x'xx',uniuocM,re a91j2A15