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12/20/2004 05:02 51®-6557464 EMERY BAY 76 PACE 02/03 <br /> R <br /> bwnor Stateinents of Desigaged UndergOund StDrW <br /> Tank(EJSI)operator <br /> and Un ding of and Canpliancc with UST kcWkcm=t3 <br /> Fadft m#: <br /> Fscisity a S Rase <br /> for su this Farm shock One) <br /> Facility A'd&ww 4)-191691 eloo� O f I.-npe of Dc* ed oP r <br /> >✓:� q U Ceaddem onDaft <br /> fecfltty <br /> '. ._,�r^�ralsrlsl this FaCili� <br /> sl6dR <br /> !vsaua ,a / stateaion to UST Facility(Pled1 <br /> 0 G Employee <br /> Bwkwa 'law <br /> Pbon- �F. vieeVTbWPehiy <br /> Dste:mcn C <br /> TF iNATE 1 Rdwd m to UST Facilby(Chuck Gita: <br /> Designated operatoes Now <br /> ' d• n! abmaek C3 Owner Q opnowGI BZnplay,=, <br /> -lti-xua(�f > 1 " t7 Sarvivc7Cor2haieisn ❑ '1'hw-p*tY <br /> beftuMd s Pbno*: <br /> igemadwa Coda cmwc4l C #: £sx1►3tsdoII <br /> too UST Fsoft(Mck OnO <br /> Hustaess NeMhe r7r if rrw im`��' 17 OWAV Q 13 rWl*' . . <br /> ted a s#: a rSer ke TcWcim U T,*d- <br /> PwW <br /> DesipaktcnWIonaI C04 Cerelfi #: Facptet4iwa Dole: <br /> NO U:M SAI-RMULATOXV AGENCY NMST EE xqoTv=OF AM 89 TO <br /> MOR�U'0014 WnIM 30DAYS OF THE CUMOL <br /> I=dfy'that,for thin facility Ind at the sop of this page,the iadividual(s)lined above will <br /> serve as Designated UST or(s)- The b&vidual(s)will conduct and doe m 1Y <br /> fusty' ons and annual Wility employee br inic&in amce with California Cade of <br /> Regq�tioM title 23,secdcm 2715(c)-(t)• <br /> Faartb►ermore,I and gad saes in ra>uap�►n"w0b the rv4� enb( tes, <br /> Malatlous,amd lewd ordba )aplOteable to U aftTmund atorIV <br /> 14ANSOFT 4.- JINgW <br /> OR OWNER'S AGENT x V it-44 <br /> -,- <br /> ' w <br /> SIG14A OF TANK `,��1 <br /> AGENTt 1 <br /> DA'I'St f 7, 'T OWNERI MONS* <br /> t-- �- <br /> Sepom <br /> ber 2004 <br /> A <br />