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Owner Statements of DesignatedUnderground St age T` : � S - <br /> and Undmtanding of and Con4gimce with UST Requiiis <br /> F " .ty N • IVICL13 76 Facility ID#: <br /> Flay / ! j <br /> a I<✓+� i s o° r 1- G N �A n (LCSo t, �� Ream for Sitanitting.this F l[QJteJ <br /> In Chimp of <br /> Facility 2 a q o$ ❑ Update g <br /> xpitation Date <br /> �u ST s1 for this ruilityDesignated , <br /> 's :ALMN NHBUMan to UST F (Chack One) 71 <br /> Busipm N (,V ): CHAMPION PRECISION <br /> ® ❑ Employee <br /> Designated s Phone#- 661-363-7400 ❑ W T <br /> Code ification#: 0978949-UC E on . 1215/08 <br /> ALTF.RNATE 1 <br /> Designated s Nsom Tqj=Sat'Satith Rehhon to UST F (Check One) <br /> ff (IJf ): aLWpIONP x TESTBVGDesignated Qpe� JxC <br /> E3 ❑ Employee <br /> 's #: 66i-363-7 ❑ ,1 Fly <br /> Wwation#: 5262033-UCFxpiration :8/1 <br /> AL ATE 2 <br /> Ddsignated s Name: Ed Stesaw Relafion to UST Fadlity(C <br /> - <br /> ® g <br /> ;One) <br /> Businm Nam <br /> U <br /> ( e): NP ISION <br /> s # 1-33-Designated0 #: PaW Third-Party <br /> 12/50 <br /> pmcowa <br /> ALURNATH37 <br /> sN=w. RonaldBAd&k to UST F (Ckeek One) <br /> B ( ):CXW10N PRECISION TES7WG INC <br /> ® Operator- ❑ Employes <br /> Designated Operawes Phane#661-363- 0 Serviet T -Party <br /> al' #: 5256869-X Bxpfiatim Date:M <br /> IN <br /> I fy for ility i top of , individual(S) listedabove will <br /> serve as USTOperator(s). The individual(s)willconduct <br /> faculty in '® f . . monthly <br /> with Cabo °a Code of <br /> Regulations, title 23, section 2715(c)-( • <br /> FurthernoM Icompliancee <br /> regulations,and 1043d GrJiRaum)applicable <br /> NAME OF TANK OWNER ); <br /> SIA F TANK OWNEIL- <br /> DATE: !®��rlZ 'SPHONE <br /> : <br /> fN <br /> STATE W,A <br /> ALA g <br /> ®L Y J A AV AT: <br /> UR <br /> teALA OF G TION DAYS 4F THE <br /> GB. <br /> Page 1 of 1 ember 2004 <br />