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Owner Statements of Designated Underground Storage Tank (UST) Operator <br />and Understanding of Compliance with UST Requirements <br />Facility Name: BP Site 2186 <br />Facility ID #: 2186 <br />Facility Address: 3212 N CALIFORNIA <br />STOCKTON, CA <br />Reason for Submitting this Form (Check One) <br />X Change of Designated Operator <br />❑ Update Certificate Expiration Date <br />Facility Phone #: 209-941-2694 <br />Designated UST Operator(s) for this Facility <br />PRIMARY <br />Designated Operator's Name: Matt Lattin <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Service Technician X Third -Party <br />Business Name (If different from above): Delta Environmental Consultants <br />Designated Operator's Phone #: 916-844-8148 <br />International Code Council Certification #: 5263293 -UC <br />Expiration Date: 7/7/2007 <br />ALTERNATE 1 (Optional) <br />Designated Operator's Name: refer to backup document <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Service Technician X Third -Party <br />Business Name (If different from above): Delta Environmental Consultants <br />Designated Operator's Phone #: refer to backup document <br />International Code Council Certification #: refer to backup document <br />Expiration Date: refer to backup document <br />ALTERNATE 2 (Optional) <br />Designated Operator's Name: refer to backup document <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Service Technician X Third -Party <br />Business Name (If different from above): Delta Environmental Consultants <br />Designated Operator's Phone #: refer to backup document <br />International Code Council Certification #: refer to backup document <br />Expiration Date: refer to backup document <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 />Name of tank Owner (print): <br />Signature of Tank Owner: <br />Date: 6/1/06 <br />Owner's Phone # (714) 690-2349 <br />In December 2004, BP West Coast Products, LLC submitted a separate letter to the local <br />agencies documenting compliance with UST regulations. A copy of this letter can be made <br />available upon request. <br />November 2004 <br />