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S <br /> 6 <br /> REC,L ". <br /> splyle0atements of Designated Underground Storage Tank Operator <br /> and Understanding of and Compliance with UST Requirements <br /> SAN JOAQUI14 COUNTY <br /> Facility� TH Facility#: <br /> ... A <br /> Address: Reason for this form: <br /> ❑ Change of Designated Operator <br /> Facility Phone#: Uc) _ 3/ �_q y 1 ■ Update Certificate Expiration Date <br /> DESIGNATED UST OPERATOR FOR THIS FACILITY: <br /> PRIMARY <br /> Designated Operator's Name: LYLE D.NIMMO Service Technician <br /> Business Name: AFFORDA-TE$T ICC# 5249115-UC <br /> Designated Operator's Phone#: 209 744-0112 Expiration Date: 7/1/2009 <br /> ALTERNATE 1 <br /> Designated Operator's Name: DAVID A.WINKLER Service Technician <br /> Business Name: AFFORDA-TE$T ICC# 5263373-UC <br /> Designated Operator's Phone#: 209 744-0112 Expiration Date: 3/27/2010 <br /> ALTERNATE 2 <br /> Designated Operator's Name: ZANE A. NIMMO Service Technician <br /> Business Name: AFFORDA-TE$T ICC# 5263322-UC <br /> Designated Operator's Phone#: 209 744-0112 Expiration Date: 3/14/2010 <br /> ALTERNATE 3 <br /> Designated Operator's Name: FELIX G RAMIREZ Service Technician <br /> Business Name: AFFORDA-TE$T ICC# 5273934-U6 <br /> Designated Operator's Phone#: 209 7440112 Ex iration Date: 6/21/2010 <br /> I certify that,for the facility indicated at the top of this page,the individuals listed above will serve as Designated UST <br /> Operators. The individuals will conduct and document monthly facility inspections and annual facility employee training,in <br /> accordance with California Code of Regulations,title 23,section 2715(c)-(f). <br /> Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local <br /> ordinances) applicable to underground storage tanks. <br /> NAME OF TANK OWNER (Print):_ . ( AAQ JL 14 A W <br /> SIGNATURE OF TANK OWNER: Q! 1%j4 <br /> DATE: 6 7, OWNER'S PHONE: ��o��J��j ,ZZ <br /> NOTE: <br /> 1)SUBMIT THIS COMPLETED FORM TO THE LOCALAGENCY(NOT STATE WATER RESOURCES CONTROL BOARD) <br /> AFTER SIGNING, THE LOCALAGENCY LIST IS AVAILABLE AT: www.waterboards.cagov/ust/contacts/cupa a�s.html/ust/contacts/cupa a�s.html. <br /> 2)NOTIFY THE LOCALAGENCY OFANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. <br />