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From: Franzen -Hill Inc. To:12098381546 Page: 314 Date: 9115120119:03:13 A[E <br />E <br />E <br />Owner Statements of Designated Underground Storage Tank (UST) Operator <br />and Understanding of Compliance with UST Requirements <br />psi ate UST Ona ) for this Facility <br />Fa7KTjTV1" <br />Designated Operator's NauteDavid Martin <br />Rotation to UST Facility (Check One) <br />0 Owner 0 Operator 0 Finployee <br />X Smice Technician X Third-Airty <br />Facility Addrcss: 1G97Yo=mitcAycF_%-4lon,CA <br />0 Change of Designated Operator <br />Updak Certificate Expiration Date <br />NMI P.-0 <br />Ell <br />psi ate UST Ona ) for this Facility <br />Fa7KTjTV1" <br />Designated Operator's NauteDavid Martin <br />Rotation to UST Facility (Check One) <br />0 Owner 0 Operator 0 Finployee <br />X Smice Technician X Third-Airty <br />Business Narne Qfdifferenrfrovs above). Franzen-flill Inc, <br />---- -------- <br />Designated Operato r's, Phone#: (5 59) 688-2977 7 <br />--------------------------- <br />L�xpiration Date.. 10/3 1/2011 <br />1111W101"WrAll T 41 <br />nx�= = <br />---------- --------- - <br />Designated Operator's Narriz. Gary Rurnmerfield -------- <br />Relation to UST Facility (Check One) <br />0 Owner 0 Operator D Employee <br />IlServiceTechnician OThird-Party <br />B usiness Namc O'difforentfront above): Franzen -Hi 11 Inc. <br />Designated Operator's Phone f,: (559) 688-2977 <br />International Code Council CertificaflioiW; 524633 I -UC <br />nx�= = <br />---------- --------- - <br />Designated Operator's Narriz. Gary Rurnmerfield -------- <br />Retation to UST Facility (Check One) <br />0 Owner It Ope=tor 0 Ealployce <br />ElService Technician oThird-Party <br />B usiness Namc O'difforentfront above): Franzen -Hi 11 Inc. <br />Designated Operator's Phone f,: (559) 688-2977 <br />International Code Council CertificaflioiW; 524633 I -UC <br />ir =041mullor, "1101 <br />cot <br />Regulations, title 23, section 2715(c) - (f). <br />217-6 =23-RAVI, 4 <br />1=7 MW <br />regulations, and local ordinances) applicabic to underground storage tanks. <br />NAME OF TANK OWNER (PIlesse Print): f34Z_0J1A1_0 4�_K Slyvy <br />SIGNATURE OF TANK OWNER: ,7 <br />DATE: - OWNER'S PHONE #.- <br />It lob 9 H <br />r4V VIPMETAKIFT, 11431014N, I FORMW4, <br />2) NOTIVY THE LOCAL AGENCY OF ANY CHANGES TO THIS 1AFORMATION WITHIN 30 DAYS <br />OF THE CHANGF. <br />Novembei-2004 <br />Thic f7v -m. cantAff, ('-r-I GAY—P­ f- -m, 9Z^r --m if ­+inn anr& rfi ^^m <br />