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07/30/2010 15: 02 20936973 SHORTSTOP PAGE 01 <br /> Jul 30 10 10: 1511 Hfr rde Test (209,-744–.0716 _ P• 3 <br /> fforda•Te t C .Ca9,et PhiFax; ( (209),14011 12 SEP <br /> Cah,Ca 95632 Fa:: (209)740]16 Q <br /> 111 lJorda[Jjadncom.net 9 2 <br /> 010 <br /> I <br /> Owner Sietement8 of Designated Underground Storage Tank Operator ?v e <br /> and Understandin of and Compliance with UST Requirements `'L�r '^:ya-_�tiUN1Y <br /> 6 P q N'airrl _COU <br /> Facility Name; Short Stop Facility k: <br /> Address[ 20 A West Tumor RdLodiCA <br /> Facility Phone#; ❑ Chanes of Deosnetcd Oncralor <br /> Q New ntaly,a 1W1 Osarvtor <br /> I)ESiGNATED U$T OPERA.1ORFO <br /> 11iLS FACILITY: <br /> PRIMARY <br /> Oesiya4e4 Ofx 's 'S Name: LANE NIMMO Sarriaa"toohmaen <br /> llmin"s N. AFFORDA TFST ICCNI V63332'-UC <br /> Dmitm•al r"ritur's pbu„e 289.744.01 t3 F%psrsion Cate'. 311,11 <br /> ALTERNATE ( <br /> Der.rrnrod Operaur's Namc. FELIX RAMIRtiZ Som.Tootai <br /> B'.lness Nmnat AFFORDATEST ICC a: R7JY1l4UC <br /> Ilasipmaed Operator S 1'ftane, 309. 44.8112 Frpimfion r+nte: 417/12 <br /> ALTERNATE2 <br /> Dc,gtnawd Onrratori Nutty: DAVIDWINKLER Snrloo'I tohnklan <br /> UW14ees Nems: AFFORDA TEST ICUs; 020173-UC <br /> Linlgnaked Openwr'S Phone: 209.744-0112 Eae:ratiom Date! 3,24.'13 <br /> ALTERNATE3 <br /> Wslstnatcd Oncruor'S Nan¢: LYLE NIMMO Scalls Taeaald4n <br /> B.Alrrs Nww AFFORDA TBSP ICC w• 12491]!-U(: <br /> JoSiynacM tiperemr s Phort:. 709•,44-0112 R'tpiraran Dao217,13 <br /> 1 Oni(; that,sur She faolllty Indleeted m the top ol'lhis pages the individuals listed aapve will serve m Designated VST <br /> Operauors. The lndl�.duals will cuadu4t End document mondny iam0ty irupealons and annual fa411lty immaNyed traimlim in <br /> Accordruscc•sith California Code nFRegulariona,title 21seetior 2711,41–lP. <br /> Furthermore,1 understand and am in Compliance with the rotiulraaleate(statutes,regulation,and local <br /> Ordinances) apptkable to undrrgroand storage tanto <br /> NAME OF TANK OWNER(Print): �.._.AZ Z <br /> SIGNATURE OF TANK OWNER: __ Uo, 44� : <br /> DATE: 7—3O — 1.e(O OWNERS PHON&1 s 3Gy_ '17. <br /> NOTE. <br /> I) iCbMiT'rH L9 CUM VLE'fli0 FORM TO T'HL l,OC1AL AGENCY(NOT ti RCg)AFTER SKIN W O,T3fE.LOCAL AUliNI'Y <br /> LIST IS AVAILABLE A'r: www Me <br /> 2) <br /> i) NOTIFY THE LOCAL AGENCY OF ANY CH ANGFS TO THIS INFORMATION WITfI!N 30 DAYS CFTHE CHANC'T. <br /> OFFICE: <br /> County; Dare Foxed: __ --Date Scainti l <br /> T00Z HHPS F %H3 4S:CT 60/60 OTOZ <br />