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0 <br /> owner Statements of Designated Underground Storage Tank(UST)Operator <br /> and Understanding of and Compliance with UST Requirements <br /> FacilityName: Tracy- B.P. Service Center Facility ED <br /> Facility Address: -Reason for Submitting this Form(Check One) <br /> 2375 Tracy Blvd XK Change of Designated Opr <br /> Trac C0 Update Cerfificate Expiration Date <br /> FacilityPhone#: 209-835-5356 <br /> JEIII esi 111,1111 p!!!,111111,111 5'�LQLer&tor sIfor this F c—ifi—q <br /> I <br /> PRIMARY <br /> Designated Operator's Name: Bruce N. Hoagland Mation to UST Facility(Check One) <br /> Business Name(Jfdfferentfrom above): Techland Testin Inc [3 Owner 0 Operator 0 Employee <br /> Designates operatoesphone g: 209-724-9420 XXsemccTechnician, 0 Thad-Party <br /> International Code Council Certification*: XX4141013189 Expi.rationDate: 11-19-2006 <br /> AI.TE ATE 1twnrrt <br /> x to US'Facility(Check One) <br /> Designated 20p7eratoe's Name:Gary Bostrom 0" T <br /> ff <br /> m <br /> Design <br /> Name(If lift above): Techland Testing, Inc 0 Owner 0 Cqmator 0 Employee <br /> hn <br /> 0 Z <br /> XXSemeeTechruman o Thud-Party <br /> ",7 op, P <br /> Desip <br /> 209-724-9420 <br /> nD <br /> International <br /> Expiration a <br /> International Code Council Cerfificafion#: BOK00014 ExpirationDate: 12-01-2006 <br /> ALTS RNATE 2 nnal) Relation to UST Facility(Check One) <br /> Designated Operator's Name: <br /> ik <br /> Bustness Name(if&fferentfrom abovq) 0 Owner 0 Operator 0 Employee <br /> rators one <br /> rDesignated Operator's Phone <br /> I t I e Council Certjficaj Expiration Date: <br /> international Code Council Certification 4: <br /> NOTE:THE LOCAL REGUIATORYAGENCY MUST BE NOTITIED OF ANY CHANGES TO THIS <br /> INFORMATION WffHIN 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 in will conduct and document monthly <br /> facility inspections and annual facility employee training,in accordance wM California Code of <br /> Regulations,title 23,section 2715(c)-(f). <br /> Furthermore, I understand and am in compliance with terequirements(Statutes, <br /> regulations,and local ordinances)applicable to underground storage tanks. <br /> NAMZ OF TANK OWNER <br /> OR OWNEWS AGENT(Please Print): <br /> SIGNATURE OF TANK <br /> OWNER OR OWNEWS,AGENT: <br /> 0 HONX# <br /> DATE: <br />