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U DERGROUND STORAGE TA K SYSTEM OWNER STATEMENTS OF DESIGNATED UST OPERATOR AND UNDERSTANDING OF AND COMPLIANCE WITH UST REQUIREMENTS For use by Unidocs,tie»,ber agencies or where approved by your Local Jurisdiction Authority Cired: Title 23, Div. 3, C'h. l6 California Code of Regudariom(CCR) FACILITY NAME Valero #3698 FACILITY PI I()NF. FACILITY SITE ADDRESS (209) 832-8815 153 East 111" Street clrY REASON FOR SUBMITTING THIS FORM/Cheri Onr/: Change of I)csignaled OperatoTraCy, hCWate of ICC Cenifi,ation (aspiration Dates) PRIMARY DESIGNATED UST OPERATOR FOR THIS FACILITY DESIGNATED OPERATOR NAME. Larry Williams RELATON TO UST FACILITY(check One/ BUSINESS NAME(lfdperrmfrom obnwl: AIp11a PetfOleunl Services, Inc. ❑ (h,ncr DESIGNATED OPERATOR PHONE ) ❑ Operator ❑ Employee (707 678-8100 est. ® Service Technician ❑ Third-Pang INTERNATIONAL CODG COUNCIL CERTIFICATION NO 5242370-UC , EXPIRATION DATE — ALTERNATE I DESIGNATED USTOPERATOR FOR THIS FACILITY(O tio„nt 8/26/2008 DESIGNATED OPERATOR NAME ,)01111 PaIeS1 ___ __ RELATION TO UST FACILITY(Check Onq BUSINESS NAME(//d�emn,from uhoir/. Alptla PetIOIQUfTI S@fVlceS, IfIC �� DESIGNATEDOPERATORPHONE _ _ I ❑ O%%ner ❑ Operator ❑ Employee (707) 678-8100 ext. ® Service Technician ❑ Third-Pany� INTERNATIONAL CODE COUNCIL CERTIFICATIONNO.: 5259473-UC I EXPIRATION DATE ALTERNATE 2 DESIGNATED UST OPERATOR FOR THIS FACILITY/Opuannl/ 10/18/2009 J DESIGNATED OPERATOR NAME: RELATION TO UST FACILITY(Check One/ BUSINESS NAME(Ifd�f/ennrfrom oboe/: DESIGNATED OPERATON PHONE: ❑ Owner ❑ Operator ❑ Employee ( ) ext. ❑ Service Technician ❑ Third-Party NTERNATIONAL CODE COUNCIL CERTIFICATION NO.: EXPIRATION DATE: ALTERNATt:3 DESIGNATED UST OPERATOR FOR TINS FACILITY(optionat/ DESIGNATED OPERATOR NAME: RELATION TO UST FACILITY(Check One/ BUSINESS NAME(lfdifjerenrfrom nbo�r/: DESIGNATED OPERATORPIIONE: ❑ Owner ❑ Operator ❑ Employee ( ) ext. ❑ Service Technician ❑ Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: EXPIRATION DATE. I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facilit}• inspections and annual facility employee training in accordance with California Code of Regulations, Title 23,Section 2715(*) through (q. Furthermore, I understand and am in compliance with the requirements(statutes, regulations.and local ordinances)applicable to underground storage tanks. TANK OWNER NAME: Valero TANK OWNER TITLE: Sand Huff, Com liance Coordinator � OWNER PHONE: 559 582-0241 TANK OWNER SIGNATURE: � !2( b (,(� Y DATE: February 14 2008 INSTRUCTIONS I. Report the name(s)of the Designated UST Operator(s) as registered with the International Code Council (ICC). ICC certification information is available on-line at: www.iccsafe.org/e/certsearch.html. 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-org/members/whoregulateswhst.html. Contact information for other local agencies within California is available at: www.swreb.ca.gov/ewphome/ust/cmUacts/docsilocal_agency_list.sI . 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. wwv,unWacs.ora U9l22/IIS