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May. 24. 2012 9:08AM MA Construction No- 3093 P. 2 <br /> UNDERGROUND STORAGE TANK SYSTEM <br /> OWNER STATEMENTS OFDESIGNAT*9D UST OPERATOR AND <br /> UNDERSTANDING OF AND COMPLIANCE 10 WITH UST REQUMMNTS <br /> Par use by Midocs Member.genies or where approved by your Local Jurisdiction <br /> AuthoNty Cited:TWO 23,Div.3,Ch.16 Calornia Code of:Regulations(CCR) <br /> FACTLI'M N--" FACILITY PHONE <br /> MANTCA ( 916 ) 439 - 6042 <br /> PACILITY SITE ADDRESS CITY <br /> 2551 E.Louise Ave. Manteca <br /> ,Rwoiq Fop.sui;mwwo THIS mRmxqie&b;w)-.--21 aeiige;?Designated op�orEj Update of ICC Certification BVIrationDate(s) <br /> PRIMARY DESIGNATED UST OPERATOR FOR THIS FACILITY <br /> Des' natcd OErators Name: PliffigDeIso rge Relation to UST facility(Check One) <br /> laussiness Name(7f dverentfmm above): Sowiwegt Vagqueer Ln&Construetors,trip- 0 Owner El Opelstor rl Employee <br /> 15osignated Operator's Phone#: (909)594-9850 LJ Service Technioian 0 Third Party <br /> International Code Council Certification#: 8012415-UC ExpirefloaDate: 3/22/2014 <br /> ALTERNATE I DESIGNATED UST OPERATOR FOR T111S FACYLITY <br /> Designated Operator'sName: Leonardo Apillar Relation to UST Facility(Check One) <br /> Bussiness Warne Ef differmf±0 above): &wWest En ng Constructors,Inc. El OWner 11 Operator El Employee <br /> Designated Operator's Phone#: (90D 594-9850 0 Service Technician M Third Party <br /> International Code Council CerfificWon#: 5302718-UC LIxkh-ationDate: 112512013 <br /> ALTERNATE I DIESIGNATE,DESIGNATE, D UST OPERATOR FOR THIS FAMTY(Opflonao <br /> Designated Operator's Mime! Dra ryn Pesic, —Relation to UST Facility(Check One) <br /> Bussiness Nome(If diffemniftom above): 9unWwt7zngbwertn&Constructors,Inc. [I Owner 0 Operator ❑ Employee <br /> Designated Oeemtoft Phone (9021594-9890 LJ Service Technician El ThirdDarty <br /> International Code Council Certification#: 5240928-UC Expiration Date, 3130/2014 <br /> A)GTERNATE 3 DESIGNATED UST OPERATOR FOR THM FACMITY r <br /> Designated Operator's Name: Todd Ransen 'Relationto UST Facility(Check One) <br /> Bassiness Name(if d&T!VMtftoM above): stlifftm Engineering ConstriactorsIne. ❑ Owner 11 Opel-ator ❑ BraPloym <br /> DesiaLftd 02=tut's Phone#; (909$94-9850 El Service Tacbstician lliiLdI'at <br /> International Code Council Certification#: 8045710-UC ExEirationDate: 11n12013 <br /> I certify'that,for lite facility indicated at the top of this page,the individuals)listed above will serve as Designated UST <br /> Operator(s),The Individual(s)will conduct and doonment monthly faeffity Inspections and anniml Aeffity employee training <br /> In accordance with California Code of Regulations,Title 23,Section 2719(e)through(1).Furthermore,I understand and am <br /> in compliance with the requirements(statutes,regulations,and local ordinances)applicable to underground storage tanks. <br /> TANK OWNER NAME: Rcq�. ,5a <br /> TANK OWNER TIME: WNBR PHONE: 74 <br /> TANK OWNER SIGNATURE: DATE.- <br /> i.Report the name(s)of the DesignatedUST Operator(s)as registered with the International Code Council(ICC),ICC coitifictition <br /> Information is available on-line at%ww.iecsareorg/e/c"enrch,htmI,Searob for"California UST System Operators." <br /> 2.Submit this completed 1bTm to the local agency that regulates this foollity's'USTs.Unidocs member agency jurisdictions and <br /> contact information are listed on-Ike at:-,vww,unidoes,orgimemborsMboregulatesivhathtml.Contact Inthrmation for other <br /> local agencies within CalifolzI4 is available at <br /> 23 CCR§2715(a)requires that you notify the local agency of any changes to this information within 30 days of the date of change. <br /> IUN-062-1/1 www.unidoes.org 9=005 <br />