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0_-._..- <br /> ---------—--------------------- <br /> 410 2"'Street Phone- (209)744-0112 <br /> ffor Te' t t <br /> i GaltCa 95632 Fax- (209)744-0116 <br /> i ifforda(i—ulsoftcorn-net <br /> Owner Siat7emicni$ of Designated 'Underground Storage Tank Operatafr <br /> and Understanding of and Com liance with UST Requirements <br /> Name; RAI - Tbornton 76 Facility, PO4 <br /> Updated Owners StUtOment <br /> Address: 8606 Thorriton Rd - Stockton CA <br /> FacilityPhone#:209-478-8959 of pcsignatcd <br /> Operator <br /> New besignattd Operator <br /> D T <br /> TQRJFOR HU <br /> 0 RECEIVED <br /> PRIMARY Service'rtchnitian <br /> n,"ijznattd operator'%Na me! 7,t NE NINIM0 <br /> ICC H. 52633,12-UC FEB 0 6 2014 <br /> AFFORDA TEST <br /> ocsignaicti Operator's Phone: Z09-744.01 12 ExpirationUitc: 31214 <br /> ENVIRONMENTAL <br /> ALTERNATE11 Serv;ccTechnician HEALTH DEPARTMENT <br /> rrLIXRAM, 1RFZ <br /> Buiiness Name: AFFORDA TEST <br /> UtijKnako operator's Phone: 209-7444)112 Expiration oatc; 312!14 <br /> A 134'RN NTE 2 <br /> DAVIDWINKLER <br /> 1114%in"s Narnc: AJFF0RDA TEST <br /> no,ignmcd opermor'i Phone: 209-7/44,0112 Expiritlion Oak. 11/14 <br /> ALTERNATF3 <br /> LYLENININIO 'Service Technician <br /> unsintqs Nslinet AFVORDA TEST ICC M 5249t l',-UC <br /> Expiration bate; 3;2/14 <br /> Phone: 209-744-0112 <br /> AurFRNATE 4 'Service Technician <br /> 9vilgas red Operator's Name: EDWARDSTEARNS ICC.ft 52-5.0492-11C <br /> 11n,tinesqNsnic- AFFORDA TEST Expiration Y)gtc-. 12/19114 <br /> j)eqjgogk(l ol-K <br /> rator,s Phone,. 209-744-0112 <br /> 1 certify thAL f0f tilt facility indicated at the top of this page,the individivils listed above will serve as Designated UST <br /> Operntors. rhe individuals will conduct and document monthly facility inspections and;annual facility OMP)oYee <br /> fi%kiniog.in <br /> Accordance with California Code of Rcgujations,title 23,section 2715(c)-(f). <br /> Furthermore,I understand nod am in compliance with the requirements(statutes,regulations,and local <br /> Ordinnnces) kpplicablc to underground storalt t,.Aukq <br /> NAME Of TANK ONVINFR(Print)- <br /> SIGNATURE OF TANK OWNM <br /> DATE:I-1-13 OWNERS PRONE; 02-0 <br /> N10Tf 11 St,,I)jNolly THIS COMPLFTED FORM TO THE LOCAL AGENCY('NOT SVN'RCR)AFTLR Sit-,NING.THL LOCAI, <br /> AC <br /> ,UNCV L M, IS AVAII-41311,AT: 111"AY"YMXrtKftr-0-—cA&v ' <br /> 21 NOTIFY T]107�LOCAL -FORM <br /> ATIO? WITHIN300AYSOFTIM <br /> Date Faxed. Date Scanncd. <br /> County, <br /> Date E-Mailed <br />