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FROM (THU)DEC 30 2004 15:00/ST. 14:54/No- 6818865749 P 2 <br /> Sall Joaquill County <br /> Environmental Health Department <br /> 304 L.Weber Ave.,Third Floor Stockton CA 95202 <br /> Telephone(209)468-3420 Fax(209)468-3433 <br /> Owner St'Iterlicill's of Designated Underground Storage Tank (UST) Operator <br /> Prid I.IndIci-standin).", of Compli,:mcc with I JST Rt-,(-pirnments <br /> .. ...................... ........... .......... .................... <br /> Facility Nuriv:Valley Ppaic-Lodi Facility ID#: N-2658-1-2 <br /> —Fi0iiy Address: Reason(br SuLinitting this Fonr. One) <br /> 633A East Victor Rd.,Lodi,CA 95240 Qange of Designated Operittor <br /> F a c i,I i ly 17960 Update Certificate Expiration Veit! <br /> ..........-- <br /> Desienate(I UST012erato (s)for this Facility <br /> PRUMARY <br /> ------------------------------- ............................... <br /> RobertRobertson 1 Rchlion to USTFacil <br /> i �ily(Check 011,7) <br /> ............ <br /> Valley Pacific Petroleum Svcs, 0%yflc:g () ()pualw '3'P;Q)CC <br /> ................ <br /> Designated Opetaloi's Phone#(209)327-8995 f (71 Service Technician D -1 hied-Party <br /> .................................... <br /> International Code Council Certification IROK00054 1 Expiration Date: <br /> ..................................... ................ ........... <br /> ALITHNATE,I <br /> Rehfinn it)IMT par-Rity(01"44 ogw) <br /> lk'siummed Opmlor's N!"114Aacle Eaker <br /> ..................................... <br /> Business Name(if diffivifi <br /> vwons abot-Volley paoiC petroleum SVCS,InC. 13 Owner LI Operator I'I <br /> 13ployce <br /> ................... <br /> lk%ipated 01-efalor'.s I'lione 11(805)878-8859......... 0 ScryiceTechnician 0 'rnira-Patty <br /> .. ............................................ <br /> 1)""Crna(lorial CNI%:coultell Cenfl-KiAliun N�EAK00016 <br /> .................... ............ . ........... txpiratran t) <br /> ............................................ <br /> AUITRISATE 2 t0ptional) <br /> ............... .... ....................... . ...... ........... <br /> Designated Opemiar's Name: Relation to UST Facility(Ch(vk On') <br /> ............................ ................... <br /> Business n Owner 0 Operator 1:3 Emplo�ve <br /> .......................... <br /> Designated Operalor's Phone 1": 0 Smicerechnician 0 "third-Piny <br /> I. .............................. <br /> International Code Council Cerfir-catioti it: Eq)iration Date- <br /> ... ............. <br /> NOTE:TJIE LOC <br /> Al.RFGI.A.A TORY AGENCM <br /> Y UST BENOTIFIED OF ANY CHANUSTO THUS <br /> INF0101ATION NVIIIIIN 30 VANS OP'THE CHANGE. <br /> ............. <br /> 1 certify that, for the tacility indicated at the top of this pagge,the individual(s)listed above will <br /> serve as Designated (TST Operalor(s). The individual(s)will conduct ond document nionthly <br /> facility inspections at'id '211"1111.1-.11 ffiCility C111ployce training,in accordance with California Code of <br /> Rc.-Ulations,title 23,section 27 1.5(c) -(f), <br /> Furthermore,I understand and ain filt compliance Nvith the requirements (statutes, <br /> regulations,and loral ordinances) applicable to underground storage tanks. <br /> NAIN1 F,OF TANK OWNI R Q'Ic-rise Print): Dale Heinze <br /> S!GNATURP',OFTANY OWNER.-__......... ..................... ................. <br /> DATE: 12/29/2004 OWNERIS PHONE ft.jg09 <br /> 12 <br /> .................. <br /> __—._------------ ................................................ ...... ........... <br /> November 2004 <br /> Valley Pacific-Lodi-max <br />