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07/05/2007 15: 45 7076788111 ALPHA PETROLEUM PAGE 02/03 <br /> 1ALPHA pETRDLE� PAGE 06/18 <br /> 06/28/2007 08:24 707678 <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> OWNER STATEMENTS OF DESIGNATED UST OPERATOR <br /> AND <br /> UNDERSTANDING Off' AND COMPLIANCE WITS UsT REQT <br /> MENTS <br /> For use by Unidocs Member Agencies Or where approved by your Local Jurfrdtcdou <br /> Aarhar(ry Cited, Jule 23, Div, 3, Ch. 16 Caltf0r"ia Code ofRWalatfons (CCR) <br /> FACILITY NAME PACTLITX PHONE <br /> Valero#3698 (209) 832-8815 <br /> FACII.xrY SITE ADDRPSS CITY <br /> 153 East 11th St. Tracy, Ca <br /> RF.A,SON FOR SUBMITTINp T'WS FORM(Check Oney Chang**£Designated Oparat*r ❑ Update of ICC Certifoation F,xplratiori Date(s) <br /> pwm"Y DI'MNATED UST OPERATOR FOR TNTS FACILITY RELATION TO UST FACTLTTY(Check Orr) <br /> tDrosiolwATEDoPEPLATORNAME: LarryWilliams © Emph ) Alpha Petroflaurn Services, Inc ❑ *urns ❑ OP�ator loy�ES5NATv18(Udr�arent am obave: 9crvicaTeohaieisn ❑ Third$ar(yNATED OPIIRATOR PHONE; (707)678-8100 ext-NATIONAL CODE COUNCI,CRRTiPICAnON NO.: <br /> 5242370-UC EXPIRATION DATR: 8/26/2008 <br /> AI.T£RNATE 1 DESIGNATED UST OFERATOIt FOR IrHIS FACILITY Boast RELATTON TO UST,FACILITY(Check Om) <br /> DFSIONAI'tD OPERATOR NAME: <br /> [] (Timer ❑ Operator [] ErnPIOycc <br /> uVSRaiSSNAME(1fdPrenr•from40w), ServiceTeebaielAn ❑ ThirclP��y <br /> 0ESICNATP.DOPERA1ORPH0NE: ( ) ext. <br /> 13XP1RATION DATE! <br /> INTERNATIONAL CODE COUNOLCERTIMQATIONNO•. <br /> ALTERNATE 2 DESIGNATED VST OPIyRATOR FOR TFIIS FACILrTY(Op[[Onat <br /> R51riTION TO UST FACILITY(Check One) <br /> DF.SIONATED OPERATOR NAME: <br /> pwner n Operator ❑ EmP1oyec <br /> BUSINESS NAME(Vd(ftma ,f0m abnr.); <br /> ❑ Third-P 9erviceTechnician ❑ artY <br /> DESIGNATED OPAItATOR PHONEt ( ) ext. <br /> EXPIRATION DATE: <br /> INTF.RNATTONAI,CORP,GOl1N611.CEftTITICATION NO.: <br /> : <br /> ALTERNATE 3 DES1Q4ATW UST OPERATOR FOR TI#tl3 FACILITY(Optional <br /> RF,I,ATION Tp UST FACILITY(Cheek One) <br /> D55 EGN ATBD OPERATOR NAME: <br /> a <br /> Ifd0emnOtam bove): ❑ Owner Elcian 1M ❑ Ernployee <br /> BUSTNE96 NAME( <br /> ❑ ServieeTsehnician ❑ Third-Parry <br /> DESIGNATED OPERATOR PHONE: ( ) ext. <br /> INTERNATIACODE COUNCIL.CERTIFICATION NO-: EXPIRATION DATE; <br /> ONL <br /> I certify that, for the facility indicated at the top of this page, the lndlvidnai(s) listed above will serve as Designated UST <br /> Operntor(s). The individual(s) will coaduet and document monthly facility inspections and aFurthermore,nnualfacility <br /> understand training and am <br /> in accordance with Calirornia Code of Regulatiotts, Title 23,Section 2715(c)through(p• <br /> In compliance with the requirements(statutes,regulations,and local ordinances)applicable to underground storage tanks. <br /> TANK OWNER NAME: Valero - <br /> .&a-4r-TANK OWNER TITLE: Sandy Huff Q�E Com fiance Coordinator owNERFFOI-m 559 582-2285'5 <br /> TANK OWNER SIGNATURE:, ! i� DATE: June 27, 2007 <br /> INSTRUaL <br /> S <br /> 1, Report the name(s)of the Designated UST Operator(s)as registered with the International Code Council(ICC). TCC certification <br /> information is available on-line at:www.icasafe.or0le%erteearch•html. Search for"Cel ifornia UST System OPeraui adlc[ions and <br /> 2. Submit this completed fort to th* local agency that regulates this facility's USTs. Unldocs member agency j <br /> contact information are listed on-line at: www.unidamorg/membert/whoregulatesvvhathtml. Contact information for other <br /> local agencies within California is available at:www.awreb.ca.gov/ewphomc/ust/cOntacts/dOcOOcal agent l'Rt`x1a. <br /> 3. 23 CCR 92715(a)requires that you notify the local agency of any changes to(bis information.within 30 days of the date of change. <br /> i)N-062-Try <br /> Irww.nnidocs.ora n?RZN! <br />