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0 • <br /> Owner Statements of Designated Underground Storage Tank (UST) Operator <br /> and Understanding of and Compliance with UST Requirements <br /> Facility Name: Pacific Gas&Electric Company—Stockton Service Center Facility ID#: <br /> Facility Address:4040 West Lane Reason for Submitting this Form(Check <br /> Stockton,CA 95204 ❑ Change of Designated Operator <br /> Facility Phone#: (209)942-1566 ❑ Update Certificate Expiration Date <br /> DesiLrnated UST Ooerator(s) for this Facility <br /> PRIMARY <br /> Designated Operator's Name: Erich Nolan Relation to UST Facility(Check One) <br /> Business Name(If different from above): ❑ Owner ❑ Operator X Employee <br /> Designated Operator's Phone#: (209)942-1566 ❑ Service Technician ❑ Third-Party <br /> International Code Council Certification#: Expiration Date: <br /> ALTERNATE 1(Optional) <br /> Designated Operator's Name:Wayne Pacheco Relation to UST Facility(Check One) <br /> Business Name(Ifdiiferentfrom above): ❑ Owner ❑ Operator N Employee <br /> Designated Operator's Phone#:(209)576-6632 ❑ Service Technician ❑ Third-Party <br /> International Code Council Certification#: 5-2L+5'To( — U Expiration Date: <br /> ALTERNATE 2 (Optional) <br /> Designated Operator's Name: Relation to UST Facility(Check One) <br /> Business Name(If differentfrom above): ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: ❑ Service Technician ❑ Third-Party <br /> International Code Council Certification#: Expiration Date: <br /> I certify that, for the facility indicated at the top of this page,the individual(s) listed above will <br /> serve as Designated UST Operator(s). The individual(s) will conduct and document monthly <br /> facility inspections and annual facility employee training, in accordance with California Code of <br /> Regulations, title 23, section 2715(c) - (f). <br /> Furthermore, I understand and am in compliance with the requirements (statutes, <br /> regulations, and local ordinances) applicable to underground storage tanks. <br /> NAME OF TANK OWNER(Please Print): Rudv Promani <br /> SIGNATURE OF TANK O <br /> DATE: 12/21/04 OWNER'S PHONE#: 415 972-5133 <br /> NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY(NOT THE STATE WATER <br /> RESOURCES CONTROL BOARD)BY JANUARY 1,2005.THE LOCAL AGENCY LIST IS AVAILABLE <br /> AT: www.waterboards.ca.eov/ust/contacts/cut)a aevs html. <br /> 2)NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS <br /> OF THE CHANGE. <br /> November 2004 <br />