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ALTERNATE 6 (Optional) E ,t E e a s -ALTH <br />Designated Operator's Name: David Martin- <br />^ ` <br />Relation to UST. Facility (Check One) <br />❑ Owner ❑ Operator ❑ Employee <br />X Service Technician X Third -Party <br />r <br />Designated Operator's Phone 559-804-4618 <br />International Code Council Certification #: 5246124 -UC <br />Expiration Date: 10=6-2016 <br />ALTERNATE 7 (Optional) <br />Designated Operator's Name: James Flowers <br />Relation to UST Facility (Check One) <br />Business Name (If different from above): Franzen -Hill Inc. <br />APR 2 4 2017 <br />ALTERNATE 6 (Optional) E ,t E e a s -ALTH <br />Designated Operator's Name: David Martin- <br />^ ` <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 559-804-4618 <br />International Code Council Certification #: 5246124 -UC <br />Expiration Date: 10=6-2016 <br />ALTERNATE 7 (Optional) <br />Designated Operator's Name: James Flowers <br />Relation to UST Facility (Check One) <br />Business Name (If different from above): Franzen -Hill Inc. <br />❑ Owner o Operator, ❑ Employee <br />X Service Technician X Third -Party <br />Designated Operator's Phone #: 559-972-5087 <br />Intemational Code Council Certification #: 8036233 -UC <br />Expiration Date: 1-8-2017 <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 />Furthermore, I understand and am in compliance with the requirements (statutes, <br />regulations, and local ordinances) applicable to underground storage tanks. <br />NAME OF TANK OWNER/ OPERATOR (Please Print): f 1✓!hG{�1' �� <br />SIGNATURE OF TANK OWNER/ OPERATOR <br />DATE: -� IF. (S— <br />OWNER'S PHONE #: V a 5'_ g 39 - / S-Gi 6' <br />NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER <br />RESOURCES CONTROL BOARD) BY JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE <br />AT: www.waterboards.ca.gov/ust/contacts/cgpa agys html. <br />2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS <br />OF THE CHANGE. <br />Page 2 <br />January 2015 <br />