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0 San Joaquin County <br />Environmental Heal► Department <br />304 E. WeberThird Floor Stockton CA 952 <br />1 <br />Telephone 01 468-3420 (209)1468-3433 <br />Facility Name: BANK OF STOCKTON HANGAg13 <br />Facility ID #: <br />Facility Address: 1941 E. LOCKHEED CT. <br />STOCKTON, CA 95206 <br />Reason for Submitting this Form (Check One) <br />X Change of Designated Operator <br />❑ Update Certificate Expiration Date <br />Facility Phone #: 483-0257 <br />Designated UST Operator(s) for this Facility <br />Designated Operator's Name: NORMAN L. WHITE <br />Relation to UST Facility (Check One) <br />❑ Owner ❑ Operator ❑- Employee <br />❑ Service Technician ❑ Third -Party <br />Business Name (If different from above): A <br />Designated Operator's Phone #: (909) 4RI-0957 <br />International Code Council Certification #: TRA <br />Expiration Date: <br />ALTERNATE i (Optional) <br />Designated Operator's Name: <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 #: <br />International Code Council Certification #: <br />Expiration Date: <br />ALTERNATE 2 (Optional) <br />Designated Operator's Name: <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 #: <br />International Code Council Certification #: <br />Expiration Date: <br />NOTE: THE LOCAL REGULATORY AGENCY MUST BE NOTIFIED OF ANY CHANGES TO THIS <br />INFORMATION WITHIN 30 DAYS OF THE CHANGE. <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 />► r ►r ►r ►r ., r i w ► ► ►. r ► <br />r ,►. <br />life 111wtr. r fu 11 r r r r r r r► <br />J� 1VF. CONTROLLER <br />y + �� • a. PHONE 19 929-1244 <br />November 2004 <br />