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San Joaquin County <br /> Owners Statement of Designated UST Operator(s) and <br /> Understanding of and Compliance with UST Requirements <br /> s <br /> Facility Name: Lawrence Livermore National Laboratory Site 300 (see Building List below) <br /> 'f Facility Site Address: Corral Hollow Road near 1-580 <br /> City: Tracy, CA <br /> Mailing Address: PO Box 808 L-633 Livermore CA 94551 <br /> Facility ID#: FA0003934 <br /> Building List UST(s) <br /> t Building 879 879-D1 U1, 879-G3U1 <br /> Building 882 882-D1U1 <br /> F, <br /> 4 <br /> The individuals named below are Designated UST Operators for each of the permitted USTs listed above. <br /> Designated UST Operator(s) for this Facility <br /> Name ICC Certification Expiration Phone Number <br /> Number Date <br /> Richard Joseph McAlice <br /> Pending12/6/2006 925 422-0169 <br /> Beverlee Morales 5241035-UC <br /> 8/31/2006 925 422-7481 <br /> Greg Wright <br /> Pending 11/17/2006925 422-0169 <br /> i <br /> NOTE: THE LOCAL REGULATORY AGENCY MUST BE NOTIFIED OF ANY CHANGES TO THIS INFORMATION <br /> 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). They will conduct and document monthly facility <br /> 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 /> C. Susi Jackson (925) 423-6577 <br /> Name of Tank OwnZowner's AgentPhone Number <br /> 12.21. od <br /> Signature of Tank r Owner's Agent Date <br /> Owners Statement—DO Form <br /> t <br />