Laserfiche WebLink
08/07/2012 12:51 FAX 2097440116 IW0001/000011 <br /> 8884/2812 10 13 2093694 sTCP T"c r '�$ <br /> 0 /03/201Y 14:e06 PAA zva U4 0 <br /> fOtdB-Te t 4s r+ PWo (209), 12 <br /> GaH,G 93632 Faz:(309)'1 l6 , <br /> aIIb aK <br /> Owner Statements of Dealpated I)ndeignmad Storage Tank Oporao r AUG 0 7 20.1Z.; '' <br /> md:Understanding of=d Gmphoice'wi6 UST RegWrements s <br /> Facilt A1ane: Shortstop F it <br /> Address: 20 A West T urger Rd:IAA CA <br /> Facility Phone*-2"-36"97 ❑"Tmm at <br /> rrvv--�� [J New <br /> CC`` <br /> ,R3LST OPS.RATORFOR 1HLS FACII,TI'Y: _. <br /> PRIMARY <br /> De*pntad bpentoPt Neune: Z NL Nv4mo S�T e _ .. .. - <br /> 1lwsaen Nem: AFFORDA TEST WC a no ru-uc <br /> Dca*w*ed Opranr•s Paene: 204-7444112 t: 312,14 <br /> ALTERNATEI <br /> De*mwd Opa ,*%m. FSLIXAANInLEZ Se ksT <br /> sar.ns Nasu: AFFORDA TEST tCC a: sr <br /> Daipeeed Upvabr`r l9lae.: 2t�T1/JIl2 Sipllatipa rr yyl,► :b ,..,.g'� <br /> ALTERNATES <br /> DeL%vmtwOpaftesNe DAVID WGYiCL11R sevae Tacki <br /> ft m N4ae: AFpO"A TEST ICC* Uc ' <br /> DewCmM Opesstar's Pheae: 2W74"112 Espinne4 . 317!(4 . <br /> ALTERNATE3 <br /> De!`4aeed opustr`s 14se: LYLE NMMo Serwce Todmidsa . <br /> reedau Nye: .... AFFORDA TEST teC a szm I Sue .-. <br /> Daequtod Opuvafar's 7h4o4: 2WT44.d112 EsP:rattea 3/L14 <br /> i tertdy drS for the tndQq'iadir4led tl th4 top oLthls Poe,the hvdtaidetak Wtad sha»wID avvs 7e�7.�3j'. <br /> gpersoxs. 76e tadivid Ws wiu eeeedme gad document ateaihty ANJW InPMC6o MA garbed bem ,. <br /> Aa rdaaeewitL Caldora4e Code ofRWlatioas•ttfte A sed%a 2715(e)—(f} g+'.-asx..- _. <br /> Nartharmore,f sndwomad am as to o Plhare with the rsgninmeab(shaNet, aged .I - - <br /> Ordiaaner <br /> NAME OF TANK OWNER(PrIst): .. .... <br /> SIGNATURE OF TANK <br /> DATE: rZ_ OWNERS PHONE- (2A-i) ,361 GY 7 <br /> Nm>=: <br /> 1) SLIBII IN"CObu'LZT D Iroaas TO TEM LOCAL AGENCY(MOT Sts'aCDI Arrm SIG .TW LOCAL <br /> AGENCS'LW ISAVAI AXLE All •nvs . <br /> 2)NDIMTaE LOCAL AGENCY OF ANY CHAMnTO'1=MOO NAYMN w4l'101e1 as 1 or I= <br /> MANG& �(� 'ST <br /> OP�1 �.JiJ Date: .. : . ,2,. <br />