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D <br /> DEG . <br /> Owner Statements of Designated Underground StTAage Tank (UST) Operator <br /> and Understanding of and Compliance with UST Requirements <br /> Facility Name:Kayo Oil Company Site#2708671 Facility ID#: <br /> Facility Address:8606 Thornton Road Reason for Submitting this Form(Check One) <br /> Stockton,CA 95209 X Change of Designated Operator <br /> Facility Phone#:209478-8959 ❑ Update Certificate Expiration Date <br /> Designated UST Operator(s) for this Facility <br /> PRIMARY <br /> Designated Operator's Name:Jerry Zimowske Relation to UST Facility(Check One) <br /> Business Name(If different from above): X Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:510-364-4452 ❑ Service Technician ❑ Third-Party <br /> International Code Council Certification#:Pending Expiration Date: 12/1/2006 <br /> ALTERNATE 1 (Optional <br /> Designated Operator's Name:See Attached Relation to UST Facility(Check One) <br /> Business Name(If different from above): X Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:See Attached ❑ Service Technician ❑ Third-Party <br /> International Code Council Certification#:See Attached Expiration Date:See Attached <br /> ALTERNATE 2 (Optional) <br /> Designated Operator's Name:See Attached Relation to UST Facility(Check One) <br /> Business Name(If different from above):USTanx ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:530-268-3949 ❑ Service Technician X Third-Party <br /> International Code Council Certification#:See Attached Expiration Date:See Attached <br /> NOTE: THE LOCAL REGULATORY AGENCY MUST BE NOTIFIED OF ANY CHANGES TO THIS <br /> INFORMATION WITHIN 30 DAYS OF THE CHANGE. <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 <br /> OR OWNER'S AGENT(Please Print): Stephen Boyd for ConocoPhillips <br /> SIGNATURE OF TANK <br /> OWNER OR OWNER'S AGENT: <br /> DATE: 12/22/2006 OWNER'S PHONE#: 714-428-6572 <br /> County of San Joaquin <br /> September 2004 <br />