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<br /> ADERGROUND STORAGE TANS;. Sy'sjrEm
<br /> OWNERSTATEATENTSOF DESIGNA'FED LTSI' OFERCATOR AND
<br /> (ADERS'rANDING OF AND COMPLIANCE WITH UST R' EQL;-jRENJf-,NTS
<br /> 011 lese 1t1 tlnidoc.v 1weltdVI,A
<br /> &MCk.y 01'Where Z►f)pr(-)j,Ld )'Your L(xo1,jjjj-jpj&-ti0jj
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<br /> REASON i:,()g ...........
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<br /> PRMARV imsl('NATED ....... .......
<br /> 1USTOPERATOR t0RTj-jVS.'FA(jLJTV
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<br /> I DESIGNATF."l)t; ------- ........
<br /> DF-SICNATI: ISVACIIATY(Opijog�,jj
<br /> Kelvin Cruz ......
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<br /> D S IGNATF.o or FRATok PI 1, � 6
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<br /> MION NO.: 2 --1:1-
<br /> ........ EXPRA IONDATF:
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<br /> OPERATOR FptiuJjrJlJ10/28/2013
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<br /> ythat, fur the Gacilky ittilk-ated at tljr. top of tj)j.s l)Ifg
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<br /> ,) will c0fl(Itlet and doctinlent rl)OL' "Ie "1(J'V'dUHJ(9 UbOve will serve as Desigriated (JIS-1-
<br /> mniij Cade of Regulkitions, Title 23,Sec.t.f(),j 271,4; 1 1 f4cill'(Y L-Iftl)loym traitling
<br /> is) accortiinee, With Calift nthly facillt, tit peet10R5 atl(, all 4
<br /> ill Compliance With the rtqjuj:,e"jrnrs regIlIzIt,olls �c) tJ1 roUgh (r), Furtlille'
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<br /> local OrdinanCO,4)jkppjiCaj)je to I morc, I Understan4l ;11)d all,
<br /> 'I ANK OWNlik'NAPYIE.: PA tanki.
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<br /> 1 ANK OWNtR SIGNATURI-.z:
<br /> DATE.
<br /> Repon the mallie(s)of the t)csignaWd (..,'S'T
<br /> the 111(em;ltional
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