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Owner Statements of Designated Underground Storage Tank (UST) QMIgr 2 0 F <br />and Understanding of Compliance with UST Requirements <br />Designated UST Operator(s) for this FacTH <br />ility <br />Facility Name: Facility ID #: <br />Facility Address: 1697 �/ {G Reason for Submitting Us Form (Check <br />Change of Designated Operator - <br />Facility Phone ❑ Update Certificate Expiration Date <br />PRIMARY <br />Designated Operator's Name: Jacob Weaver Relation to. UST Facility (Check One) <br />Business Name (If d fferent from above): Franzen Hill Corp. ❑Owner ❑Operator ❑ EmpIoyee <br />Designated Operator's Phone 559-688-2977 X Service Technician - X Third -Party <br />International Code Council Certification #: 8338858 -UC Expiration Dater 3-5-2017 <br />AT.TF.RNATF 1 /f).#;--- n <br />Designated Operator's Name: Gary Rummerfield <br />Relation to UST Facility (Check One) <br />❑Owner _ a Operator ❑Employee <br />X Service Technician X Third -Party <br />Business Name (Ifd fferent from above): Franzen -Hill Corp. <br />Designated Operator's Phone #: 559-804-4618 <br />International Code Council Certification #: 5246124 -UC <br />AT'rI DAT ATL+s <br />Expiration Date: 2-25-2017 <br />Designated Operator's Name: Gabriel Venegas <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator , ❑ Employee <br />X Service Technician X Third -Party <br />Business Name (If d fferent from above): Franzen -Hill <br />Designated Operator's Phone #: 559-331-8769 <br />International Code Council Certification #: 8123651 -UC <br />Expiration Date: 7-1-2016 <br />Designated Operator's Name: Adam Taylor <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />X Service Technician X Third -Party <br />Business Name (If d fferent from above): Franzen -Hill Corp. <br />Designated Operator's Phone #: 559-731-0271 <br />International Code Council Certification #: 8036233 -UC <br />Expiration Date: 1-21-2017 <br />Nrrlydrll I <br />Designated Operator's Name: Jose Ochoa <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />X Service Technician X Third -Party <br />Business Name (If different from above): Franzen -Hill Corp. <br />Designated Operator's Phone 559-688-2977 <br />International Code Council Certification #: 8004551 -UC <br />Expiration Date: 1-21-2016 <br />Designated Operator's Name: Junior Sinco <br />Relation to UST Facility (Check One) <br />❑Owner ❑Operator ❑Employee <br />X Service Technician X Third -Party <br />Business Name (If d fferent from above): Franzen -Hill Corp. p <br />Designated Operator's Phone 559-331-8769 <br />International Code Council Certification #: 5246152 -UC <br />Expiration Date: 11-11-2016 <br />Page 2. <br />January 2015 <br />