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Nov 30 06 11:12a AfFnrda Test (2001 744-0116 p.2 <br />Owner State=nts OfDCSisnatcd Underground Stozagc Tank (UST) Operator <br />=d Ilndorstandrro of and Coznp�iancc with UST Requirements <br />� rec.rq narx <br />C. i Frcility ID W <br />cw.00 !U* Subon+King talo Porm (C/m* O,.e) <br />Poc;lity t'hono 4: �� Cha*�Ite o(D%iV'tcj Oporslar <br />a Cr- tc CcrGficaic ] Eo;�:on 1)eto <br />LT <br />I ecrdfy that, for the flinty i:idicated ut 1110 top of thi-q page, the individuai(s) listed above will <br />SWve as Desigzatcd UST Operator(s). The individuals) will condvet and document moa:.b'.y <br />acilfty inspocticas and annual 1`4661:y cmployCC training, in accordancc'wAh Cialifbrr•nia Code of <br />RCgUlutiet % title 23, suction 2715(c) - (f). <br />Furthermore. I underlttnnd nod am itR COrnpii"CC with the requirernentll (<t8tute+y <br />r0Pln6arr?4 and local ordinances) applicuble to and round %tarage tank.. <br />NAME OF TANK <)\XIK)ER (PfrHsr print):i442-� <br />SK-NATURQ nt"TANK (?wN&R; <br />DATt: '7/eO2lAnlc <br />No�rtrt-,r 2004 <br />ncrf((nxua Opar rota Namr. (. `Q ux� r►1/Y1 G <br />Rwa%ioD to USS 1+04ilily (( hork Owe <br />Awitiee� Ntrno ({jdeni jF aberslr %� �' a Yep - �e <br />Destgn+auaQW.— <br />oparanx'o Pliax yr 209 - Q 1 2 <br />❑ C OPo,.ser o pvoptvyoe <br />Sarvice Teatutictian a Tr�.sParq <br />I^Sanetiowal caae Council cwArACos%iva tr `iA 11'� •+2►.; t= C <br />expirClioe nam: Jif 7Oi= <br />CIiltlY B <br />Dc,i�otod ODomta's 7damc: �}L� A . HLQ__, <br />RX1000 to UST raciltw (Chwot QW) <br />Elueioas IJen•c (/j.11�sYlrnlfiY.n. abovyr _ <br />a Owacr 0 O porntPr ❑ �P.mptay:e <br />4oaignatoGOperoterevboaelk ?�r.�-7t���_n� r <br />X 5�rvieeTeolcrtiui�w ❑ Tl.i,d�l+atq <br />fu Zf oeal C«le Council Ccnifcnued 11 ��:2� <br />ts%jdratlOa OEM <br />z fG�uww✓1 <br />D-ign°tod Opca 'a Nnnw, A \ <br />icela(ioq to U9T r.l y (Check Ona) <br />iA.,i.ro,a N.Fnp (I%clrffrra�Jwrn aAnw): �- <br />,l _ <br />♦7GiQpeL)4 Oparuinr'a Phone M'f <br />d <br />Q pwaQ CJ tvMtor o i`MVI..yae i <br />ZtI Sameb Toot me'= o Thad." f <br />faMewdioml COO Cmmm, C=uIlci alue mcpiration <br />nweG i . <br />NOM, THE (.00A(. R1GCT( LATORY AGENCY IVIVST AE N077]r[lr,)D OF ANY CimmP <br />INYMMAT1ON WITFBW 30 DAYS OF -Mg CHA.NCi; <br />Es To Tim <br />I ecrdfy that, for the flinty i:idicated ut 1110 top of thi-q page, the individuai(s) listed above will <br />SWve as Desigzatcd UST Operator(s). The individuals) will condvet and document moa:.b'.y <br />acilfty inspocticas and annual 1`4661:y cmployCC training, in accordancc'wAh Cialifbrr•nia Code of <br />RCgUlutiet % title 23, suction 2715(c) - (f). <br />Furthermore. I underlttnnd nod am itR COrnpii"CC with the requirernentll (<t8tute+y <br />r0Pln6arr?4 and local ordinances) applicuble to and round %tarage tank.. <br />NAME OF TANK <)\XIK)ER (PfrHsr print):i442-� <br />SK-NATURQ nt"TANK (?wN&R; <br />DATt: '7/eO2lAnlc <br />No�rtrt-,r 2004 <br />