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Owner Statements of Designated Underground Storage Tank (UST) Operator <br />and Understanding of Compliance with UST Requirements <br />Facility Name: ARCO 02093 <br />Facility ID #: 02093 <br />Facility Address: 3425 TRACY BLVD <br />TRACY, CA 95376 <br />Reason for Submitting this Form (Check One) <br />■ Change of Designated Operator <br />❑ Update Certificate Expiration Date <br />Facility Phone #: (209) 835-1605 <br />PRIMARY <br />Designated Operator's Name: James Wolf <br />Relation to UST Facility (Check One) . <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Service Technician ■ Third -Party <br />Business Name (If different from above): Belshire Environmental Services, Inc. <br />Designated Operator's Phone #: (949) 460-5200 <br />International Code Council Certification #: 5296382 -UC <br />Expiration Date: 10/12/2008 <br />ALTERNATE 1 (Optional) <br />Designated Operator's Name: refer to backup document <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Service Technician ■ Third -Party <br />Business Name (If different from above): <br />Designated Operator's Phone #: refer to backup document <br />International Code Council Certification #: refer to backup document <br />Expiration Date: refer to backup document <br />ALTERNATE 2 (Optional) <br />Designated Operator's Name: refer to backup document <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />❑ Service Technician ■ Third -Party <br />Business Name (If different from above): refer to backup document <br />Designated Operator's Phone #: refer to backup document <br />International Code Council Certification #: refer to backup document <br />Expiration Date: refer to backup document <br />Designated UST Operator(s) for this Facility <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 individual(s) will conduct and document monthly <br />facility inspections and annual facility employee training, in accordance with California Code of <br />Regulations, title 23, section 2715(c) - (f). <br />Name of tank Owner (print) <br />Signature of Tank Owner: <br />Chris Moul <br />Date: 01/08/08 Owner's Phone # (714) 690-2349 <br />