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04/13/2009 15:24 FAX 17074466192 <br />c -1, 0 <br />TANK-TEK <br />• <br />UNDERGROUND STORAGE TANK SYSTEM <br />OWNER STATEMENTS OF DESiGNATED UST OPERATOR AND <br />UNDERSTANDING OF AND COMPLIANCE WITH LST I,ZEQUTREMENTS <br />For use ht,' Unicfocs Member ASeames a• w/rere appr wed b3 your Lural Jurisdretina <br />,4m lrarin, Chad. 7 -ale 1. Air. 3. Ch 16 Culiforrria Codi gt'Regulations (CM <br />IA 003/004 <br />FACILTY SAME : %cgxi y P14ON <br />CRLLC #2705447 209-478-1522 <br />�tctt. tY SI C[ ADDRIM ci ry <br />1469 E. HAMMER LANE , STOCKTON <br />i REASON FOR .wourr-rwo Tmm Kwst rr QarP Chmpt of Designated opc uor l:pdata of WC Crnidodson L'>pirali to Dare(3) <br />PRIMARY DESIGNATED UST OPERATOR FOR THIS FACILITY <br />VOIGNATED OPERATOR N&mE• Daniel Lawrence RV ATua� M UST FACILITY frk v1 crow-iI <br />sustN9z NAh 9 pf fr— ab—r_ Tank -Tek EnvironmeaUl Corp. F Ioyta i <br />DEStONATF.Dp TOR PHONE• (yo7)448-6161 9%I` ® Scrvicc Tcchnician Third -PA .- I <br />NMRSATtO.NAL CME COUNO, MTTPCATM NO.. 8026453-1,IC OWMAMOv DATE. 3/14/2011 i <br />A16TERNATE t DESIGNATED LIST OPERATOR FORMS FACILITY ! omni <br />DPSIGNATED OPER,ATIM RAW- Richard Thomas T ON TO IAT FACR.ITY t keek Ones <br />9CL4td'tESS �NMBI�/ 8erencJ>rorxabereJ• Tank -Tek Eriyironmenta l Corp. 1 ❑ 0"Cr ❑ Operu/or ❑ ETM1(,) x <br />DESIGNATED OPERATOR PROXE: (707) 44"151 ext. ❑ Scevica'ftxhnician ® Thud -Patty <br />NITRNATiObAL Coot: COUNCIL CER.TiFICA-11ION NO:: 5254736 -UC j F.XPtaArto-, DAM 1120/2011 -- <br />�r�r3_4�ti������7thvtr�is>'i��rl��3;��:+:err+aax•���I�.�i.'�nNt�r�-rrr�-rtt <br />DESMATED OPERATOR'•'AJkM, Michael (Mike) Lawrence <br />R€IAMN 1'0 U37 FACILITY (Check&el I <br />❑ Owlur ❑ OP-ruor ❑ Employ lI <br />❑ 5=iee Technkisn ® Third -Puny j <br />®USINI S NAME Tank -Tek Environmental Corp. <br />w <br />DESONA7TDOPIMATOR PHONE170 X151 ext <br />IN-MRNATIONAL Ct7DE COUNCIL CERTIFICATION ©O- 1048103 -UC <br />EXPUtAT1oN DATA_; 10/12/2009 <br />ALTERNATE 3 DESIGNATED USC OPERATOR FOR THIS FACILITY (Opdanao <br />DESIGNATED OPERATOR NAME: VIrginia Fulgaro RELATION TO V.ST FACIMY (Chrek fowl <br />latslt s ur -%rfi--b-t)_ Tank -Tete Fnrironmentid Corp, ❑Oumer ❑ Operator ❑ Empto:ce <br />DEW,NATW OPERA7UR PH04%, (707) 151 ❑ $cryiso Tce:hni6un ® Third -Pan% <br />INTERNA CODE COLJ%'c'L CERTwicATKN �* . 5322644 -UC LXPAPUNTION DATE: 11117/2009 <br />1 certify tb*L for the facility indicated at the top of this page, the iledividoal(s) listed above will serve as Designated UST <br />Operttot% The Individuals) will Conduct and document monthly facility i0pecdons and annual facility employee training <br />in accordance with Caffornia Code of ftegulsfion& Title 23, Section 2715(c) through (q. Furthermore, I understand and alp <br />in compilaisce wkb the requirvirtents(statutes, regulations. sad total ordinances) applicabie to underground storage tanks. <br />Ilti1:_I;tl`.'iRi\�t_a\ TIi <br />TANK OWNER 71TL.E: <br />TANK OUNEP. SIGNATURE! <br />[rSTRt;CTigNs <br />DATE <br />I. Report the namc(s) of the Lksil noted UST dperawr(s) ae registcmd with the tntcmmionrl Code Council (1('.C). ICC ccnification <br />'Ca is available ott-lute; at: www.iccbprc.OrWeleertse>areh.himl. Scumb for -California UST System operators;' <br />2. Submit this Completed foam to the: local agency that regulates this Facility .5 Mi. Unidocs member agency jurisdictions and <br />contact ittlomtmtion mr listed tan -tine au: www.unid6o.org/miemberVwhoregulateswbat.litmi, Contact infornaation for other <br />[on) agcneics within CaiiFomia is a%milable ar- vww swreb.cagoviewphomeiu ticnntactddnt:ctlncal^ugency_IisLsls. <br />3. 23 CCR :271 s(al rtzyutre, ih:i: ti uu nality the hwal auenp, ul :an\ changes to th16 info n'aaauir Hathin =0 da%r of the date of change <br />t `- 2. 1%1 hun unitliu'. esry ulM lit <br />