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lkilay 04,11 03:07p Reliable PetroleumA 209-845-8953 p.10 Owner Statements of Designated Underground Storage Tank (UST) Operator an Understanding of and Compliance with UST Requirements Facility Name:SHEL 1-5 Facility ID#: Facility Address: 71 W.81"Street,Stockton CA 95206 Reason for Submitting this Form(Check One) Change of Designated Operator Facility Phone 9: 2010-939-0961 X Update Certificate Expiration Date Designated UST Operator(s) for this Facility PRIMARY Designated Operator dame: Robert Barnhart Relation to UST Facility(Check One) Business Name(If di Brent from above):Reliable Petroleum Services Inc. ❑ Owner ❑ Operator ❑ Employee Designated Operator Phone##: 209-604-9336 X Service Tecnnician D Third-Party international Code C unci]Certification#: 5252540-CC Expiration Date: 12-23-2011 ALTERNATE 1 lona] Designated Operator Tame:Guadalupe Sanchez Relation to UST Facility(Check One) Business Name(Ifdi Brent from above):Reliable Petroleum Services Inc. ❑ Owner ❑ Operator ❑ Employee Designated Operator Phone#:209-604-9363 X Service Technician O Third-Party International Code C unci!Certification#:5250451-UC Expiration Date:01-29-2013 ALTERNATE 2 (O tion!) Designated Operator' Name: Relation to UST Facility(Check One) Business Name(If di I erent from above): ❑ Owner ❑ Operator ❑ Employee Designated Operator' Phone#: ❑ Service Technician ❑ Third-Party International Code Ci luncil.Certification#: Expiration Date. I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Design ed UST Operator(s). The individual(s) will conduct and document monthly facility inspectio is and annual facility employee training,in accordance with California Code of Regulations,title 23,Section 2715(c)- J)- .Furthermore, I nderstand and am in compliance with the requirements(statutes, regulations,and local ordinances) applicstorage tanks. NAME OF TANK OWNER(Please Print): SIGNATURE OF I ANX OWNER: �--k DATE: 06— 4. 1 OWNER°S PHONE#: 'p 6 6 b6QD tiOTE: I)SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CON rRoL BOARD)BY JANUARY 1,2005,THE LOCAL AGENCY LIST IS AVAILABLE AT: .._ w:i :-rh,Iar' ..: w.�t,u.�C.:Jc17:;iCi�_.!r•_:-j._t�:.?•_c�?: 2)NOTIFY THE Ll ICAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE