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a <br /> /ED}' L] 416 2"d Street Phone: (209)744-01 2 ENoi+ —Te Galt,Ca 95632 Fax: (209)7440116 <br /> afforda(r softcom.net. 14 <br /> Owper Statements of Designated Underground Storage Tank Operator <br /> and Understanding of and Compliance with US's Requirements ENVIRONMENTAL HEALTH <br /> Facility Nawe: Delta Arco Facility#: <br /> Address: 440 W Charter Way Stockton. CA <br /> Facility Phone#:209-46524$7 Q Update of Designated Operator 1 <br /> ❑ New Designated Operator <br /> DESIGN4TED UST OPERATOR FOR THIS FACILITY: 5 <br /> PRT-MARY <br /> Designated Operator's Name: ZANE NINIM0 Service Technician <br /> Business Name: AFFORDA TEST 3CC 4: 5263322-UC <br /> Designated Operator's Phone: 209-744-0112 Expiration Date. 313/16 <br /> ALTERNATE <br /> Designated Operator's Name: FELLX.RANI REZ Service Technician <br /> Ruiiness Name: AFFORDA TEST ICC#: 52733934-UC <br /> Designated Operator's Phone: 209-744-0112 ;Expiration Date: 3/3/16 <br /> ALTERNATE 2 <br /> Designated Operator's Name: DAVID WINKLER Service.Technician <br /> Business'Name: AFFORDA TEST ICC#: 5263373-UC <br /> Designated Operator's Pbone: 209-744-01112 Expiration Date: 3/10.116 <br /> ALTER1NiATE 3 <br /> Designated Operator's Name: tOWARD STEARNS Service Technician <br /> Business Name: AFFORDA TEST 1CC# 5250492-13C <br /> Designated Operator's Phone: 209-744.01.1.2 Expiration Date: 35/1.6 <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 <br /> 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 /> Ordinanees) applicable to underground storage tanks. <br /> NA1VlE OF TANK.OWNER(Print'; <br /> SIGNATURE OF TANK OWNER: <br /> DATE: 2• '�- - ) OWNERS PHONE: 2-00 1 --q 31 2L <br /> NOTE: <br /> 1.1 SUBAIIT THIS COWIPLETED NORM TO THE 1.,OCAL AGENCY(NOT SWRC.R)AFTER SIGNING.THE LOCAL <br /> AGENCY LIST IS AVAILABLE AT: vw.tivatcrba8rd mlust/cont a2vs.htnil. <br /> 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS 1NPORM4,TION WITHIN 30 DAYS OF THE <br /> CHANGE. <br /> OFFICE: <br /> County: (�c_C- Date Faxed: LA'114 Date Scanned:-:r� r� <br />