COMPLIANCE INFO 2001-2006 - Laserfiche WebLink

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Owner Statements of Designated Under rage Tank(UST)Operator and Understanding of a! I race with UST Requirements—continued ALTERNATE 1 O trona! Designated Operator's Name:Blake Hemess Relation to UST Facility(Check One) Business Name(If diiferentfrom above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:800/253-8054 ❑ Service Technician ❑x Third-Party International Code Council Certification#:Not Available Expiration Date:Not Available ALTERNATE 2 (Optional) Designated Operator's Name:Cindy Padden Larson Relation to UST Facility(Check One) Business Name(Ifdifferentfrom above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#: 800/253-8054 ❑ Service Technician ® Third-Party International Code Council Certification#:5243667-UC Expiration Date: 10/31/2006 ALTERNATE 3 (Optional) Designated Operator's Name:Daniel Perez Relation to UST Facility(Check One) Business Name(Ifd fferentfrom above). Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:800/253-8054 ❑ Service Technician © Third-Parry International Code Council Certification#:5246161-UC Expiration Date: 11/30/2006 ALTERNATE 4 (Optional) Designated Operator's Name:Darrell Riley Relation to UST Facility(Check One) Business Name(Ifdi$erent from above):Gilbarco/Veeder-Root ❑ Owner. ❑ Operator ❑ Employee Designated Operator's Phone#: 800/253-8054 ❑ Service Technician ® Third-Party International Code Council Certification#:Not Available Expiration Date:Not Available ALTERNATES (Optional) Designated Operator's Name:Darren J.Austin Relation to UST Facility(Check One) Business Name(Ifdiiferentfrom above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:800/253-8054 ❑ Service Technician O Third-Party International Code Council Certification#:Not Available Expiration Date:Not Available ALTERNATE 6 (Optional) Designated Operator's Name:Eric Banghart Relation to UST Facility(Check One) Business Name(Ifd fferentfrom above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:800/253-8054 ❑ Service Technician O Third-Party International Code Council Certification#:Not Available Expiration Date:Not Available ALTERNATE 7 (Optional) Designated Operator's Name:Rayner Guttman Relation to UST Facility(Check One) Business Name(Ifdifferentfrom above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:800/253-8054 ❑ Service Technician ® Third-Party International Code Council Certification#:5245973-UC Expiration Date: 11/16/2006 ALTERNATE 8 (Optional) Designated Operator's Name:Ron Larson Relation to UST Facility(Check One) Business Name(Ifdfferentfrom above):Gilbarco/Veeder-Root ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:800/253-8054 ❑ Service Technician ❑O Third-Party International Code Council Certification#:5243829-UC Expiration Date: 10/31/2006