COMPLIANCE INFO 2004 - 2006 - Laserfiche WebLink

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by 0 BP West Coast Products LLC 4 Centerpointe Drive La Palma, CA 90623 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of Compliance with UST Requirements Facility Name: 5469 Facility ID #: 5469 Facility Address: 130 S.WILSON WAY STOCKTON CA 95205 Reason for Submitting this Form (Check One) X Change of Designated Operator ❑ Update Certificate Expiration Date Facility Phone #: 209466-6633 Expiration Date: 2007-07-07 00:00:00 Designated UST Operator(s) for this Facility PRIMARY Designated Operator's Name: Brian Ellsworth Relation to UST Facility (Check One) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician X Third -Party Business Name (If different from above): Delta Environmental Consultants, Inc. Designated Operator's Phone #: 916-524-6974 International Code Council Certification #: 5263224 -UC Expiration Date: 2007-07-07 00:00:00 ALTERNATE 1 (Optional) Designated Operator's Name: refer to backup document Relation to UST Facility (Check One) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician X Third -Party Business Name (If different from above): Designated Operator's Phone #: refer to backup document International Code Council Certification #: refer to backup document Expiration Date: refer to backup document ALTERNATE 2 (Optional) Designated Operator's Name: refer to backup document Relation to UST Facility (Check One) ❑ Owner ❑ Operator ❑ Employee ❑ Service Technician X Third -Party Business Name (If different from above): Designated Operator's Phone #: refer to backup document International Code Council Certification #: refer to backup document Expiration Date: refer to backup document I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Name of tank Owner (print): Chris MOLII Signature of Tank Owner: Date: 8/30/2005 Owner's Phone # (714) 690-2349 In December 2004, BP West Coast Products, LLC submitted a separate letter to the local agencies documenting compliance with UST regulations. A copy of this letter can be made available upon request.