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05/06/2033 02:19 2093331069 PAUL KOONTI 0 PAGE 06 <br />• <br />San Joaquin County <br />Invironmental HeWt4 Department <br />K Main Street Stockton CA 95202 <br />TdOPbOne (2") 3420 Fax (2") <br />Owner Statementsof IX-signated Underground Storage Tank (UST) Operator <br />+' Understanding of and compii=m with UST Requirments <br />loc. rril-W46M <br />' w - <br />/1 f. <br />1 <br />fit <br />f { <br />!31_.i�.,�hl ii�i"�i ftWm 1 <br />-EMAI <br />1 f • 11 L / <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 iodividual(s) will conduct and document monthly <br />facility inspoctions and annual facility employee training, in accordance with California Code of <br />Regulations, title 23, section 2715(c) - (f). <br />Furthermore, I understand sad am 10 compliance with the requirements (statutes, <br />regulations, and local ordinances) applicable to underground nd a tanks. <br />NAME 4P TANK b PrIst): <br />SIGNATURE OF TANK OWNER: � <br />MATE: r� `�..� 's PHOXVE <br />November 2004 <br />! �T , <br />R#nt1n to UST Fedlity <br />. Sami. ,:. • <br />�... ..: .:: <br />pi <br />//sem W��. <br />�...: .I..;:ployot <br />.1 f • ::7,1 1 .. <br />!31_.i�.,�hl ii�i"�i ftWm 1 <br />-EMAI <br />1 f • 11 L / <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 iodividual(s) will conduct and document monthly <br />facility inspoctions and annual facility employee training, in accordance with California Code of <br />Regulations, title 23, section 2715(c) - (f). <br />Furthermore, I understand sad am 10 compliance with the requirements (statutes, <br />regulations, and local ordinances) applicable to underground nd a tanks. <br />NAME 4P TANK b PrIst): <br />SIGNATURE OF TANK OWNER: � <br />MATE: r� `�..� 's PHOXVE <br />November 2004 <br />