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09/0412009 00:4G 2099510372 9TEPHE€S-RIVPT LHD � CJEpA !Sep 03 0113 12: sep F 'or`da Test (2C 7# <br /> r� *MWd <br /> SEP - S 2008 <br /> Owner Statement of Designated Underground Storage r tor- <br /> and Understa ding of and Compliance with C-STRe ��b�tiTAL ', <br /> HEALTH L)EPAKMENT <br /> li rn; <br /> Facility Phone Y`- w Chap e u'Dd,%i P4:cd O <br /> eratcir <br /> L:pdatecettifcateFxp,.tatiolI <br /> Date <br /> DESIGNATED UST OPERATOR FCIt`t JMS FACT"TY: <br /> PR 1!"►'IARYY <br /> T]esignr.ted Operator's Name:qA <br /> D-NIMMO Semce."Technician <br /> Business Name= DA-TE$I' tcc5249115-LC <br /> DesignatedOperator's Phone 011_F Expiration matt: 7:1/'-70W <br /> ALTERNATE 1 <br /> LD, natv-d()perator'a Tame- VIDA.NVINKLFR Semee T"heician <br /> A FCst DA-TEST' FCC'# 5263;373-11C <br /> tatzd C9parator's Phone#. "Q 744-0172 <br /> ALTERNATE 2 <br /> Lils, <br /> Z Nl A,. `4Y1b MO Service Technician <br /> A FOR.DA-i`F,$T icciv 5263322-UC:opcirator'=.Phone : 20 P 744-0112 Fspiraticn Dale; 3;'14/20!0 <br /> ALTERNATE 3 <br /> Desibra:e Optrator's Name: ' F LLX G 1LA M1RE7., Scrvi.ce Technician <br /> Business Name: Af rORD_a,-TE$T 7CG4 5.273934-t,J6 <br /> Dcsignated LV&ratar's Phenc 0: 2 7"-ot 12 ex Iratior:Date: 6/21/2010 <br /> f certily that,for the facility indicated st the Cop of this page,the individuals listed above will serve as DLsignated UST <br /> Operators, The individuals wi.11 conduct ind aocument monthly facility inspections and 2nnual fsciliri employee truiniag,in <br /> accordance«ith Calif:)rnia Code of Reg ulabon.%title 23,section 2715(c)-(f). <br /> Furthermore, C understand and am In compliance with the requirements (statutes, regulations, and local <br /> urdtnanees) applieable to u>ndergr d stDrage tanks. <br /> NAME OF T_4'r"K OWMER (Print): �` �DMIK V�� MII: Rjr <br /> SIGNATURE OF TANK OWNER: <br /> DATE. 041r'NER'$laH0NV-. _'ag R <br /> 1)SU841l`i"'C'IMCoY PLErEr)jFoRm i D THE LC)CAI—Af,;t£1sFCY(NOT SFATE,WATER RESGURCESCONTROL,I1CJARI7j <br /> AFTER SICti1PiC. '{`HL'+ L(X ALAGENt ZY LIST 1S AVAIL ABLE AT: MMw,water6c��rds�cx� �:�sss 'cnnu►cislcuoa pjYAhfjn1. <br /> 2)140TIFYTH.ELOCkLAGENOVOI YCI4ANCFSTOTUISINFORMATIONWIT MIN 30DAY5OFTHCCHANGE. <br />