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Owner Statements of Designated Underground Storage Tank (UST) Operator <br /> and Understanding of and Compliance with LIST Requirements <br /> Facili!y Name: WestLane Fuels Facility ID#: FA0003847 <br /> Facility Address: Reason for Submitting this Form (check one) <br /> 3300 WestLane ER Change of Designated Operator <br /> Stockton, Calif. 95204 0 Update Certificate Expiration Date <br /> Facili Phone#: (209)466-1682 1 <br /> Designated UST Operator(s) for this Facility <br /> Primary <br /> Designated Operator's name: Dan Mcllrath Relation to UST Facility(check one) <br /> Business Name: Valle y Under round Tank Monitoring E30wner 00perator FlEmployee <br /> Designated Operator's Phone#: (209)476-1805 El Service Technician Q Third-paq <br /> International Code Council Certification #:XX4141012575 lExpiration Date., 11/13/2006 <br /> Alternate I <br /> Designated Operators name: Relation to UST Facility(chec;kone]) <br /> El <br /> Business Name: ❑Owner 00perator []Employee <br /> Designated Operators Phone#: El Service Technician El Third_ a <br /> International Code Council Certification #: Expiration Date: <br /> Afternate 2 <br /> Designated Operators name: Relation to UST Facility(check one) <br /> Business Name: ElOwner ElOperator ElEmployee <br /> Designated Operator's Phone#: El Service Technician 11 Third-paq <br /> International Code Council Certification #: I Expiration Date: <br /> Note: THE LOCAL REGULATORY AGENCY MUST BE NOTIFIED OF ANY CHANGES TO <br /> THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. <br /> I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as <br /> Designatd UST Operator(s). The individual(s)will conduct and document monthly facility inspections <br /> and annual facility employee training, in accordance with California Code of Regulations, <br /> title 23, section 2715(C)-(F). <br /> Furthermore, I understand and am in compliance with the requirements(statutes, regulations, <br /> and local ordinances)applicable to underground storage tanks. <br /> Name of Tank Owner <br /> or Owner's Agent(Please Print): Jay MgILrath <br /> Signature of Tank <br /> Owner or Owners Agent: <br /> 7-7 <br /> Date: 12-15-2004 Owner's Phone : (209)462-4685 <br />