Laserfiche WebLink
by t <br /> BP West Coast Products LLC <br /> 4 Centerpointe Drive <br /> La Palma,CA 90623 <br /> Owner Statements of Designated Underground Storage Tank (UST) <br /> Operator <br /> and Understanding of Compliance with UST Requirements <br /> Facility Name: 9600 Facility ID#: 9600 <br /> Facility Address: 1250 N WBSON WAY <br /> STOCKTON CA 95202 Reason for Submitting this Form(Check One) <br /> Facility Phone#:209465-5359 X Change of Designated Operator <br /> ❑ Update Certificate Expiration Date <br /> Designated UST Ooerator(s)for this Facilitv <br /> PRIMARY <br /> Designated Operator's Name:Brian Ellsworth Relation to UST Facility(Check One) <br /> Business Name(Ifdifferent from above):Delta Environmental Consultants,Inc. ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:916-524-6974 ❑ Service Technician X Third-Party <br /> International Code Council Certification#:5263224-UC Expiration Date:2007-07-07 00:00:00 <br /> ALTERNATE 1(Optional) <br /> Designated Operator's Name:refer to backup document Relation to UST Facility(Check One) <br /> Business Name(Ifdifferentfrom above): ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:refer to backup document ❑ Service Technician X Third-Party <br /> International Code Council Certification#:refer to backup document Expiration Date:refer to backup document <br /> ALTERNATE 2 (Optional) <br /> Designated Operator's Name:refer to backup document Relation to UST Facility(Check One) <br /> Business Name(If different from above): ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:refer to backup document ❑ Service Technician X Third-Party <br /> International Code Council Certification#:refer to backup document Expiration Date:refer to backup document <br /> I certify that, for the facility indicated at the top of this page,the individual(s) listed <br /> above will serve as Designated UST Operator(s). The individual(s)will conduct and <br /> document monthly facility inspections and annual facility employee training, in <br /> accordance with California Code of Regulations,title 23, section 2715(c)- (f). <br /> Name of tank Owner(print): Ch�riss Moul <br /> Signature of Tank Owner: zo <br /> Date: 8/30/2005 Owner's Phone# (714) 690-2349 <br /> In December 2004,BP West Coast Products, LLC submitted a separate letter to the <br /> local agencies documenting compliance with UST regulations. A copy of this letter <br /> can be made available upon request. <br />