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01/07/2011 15:53 559688147 FRANZEN HILL PAGE 02/02 ''s JAN Owner Statements of Designated Underground Storage Tank (UST) Qper oi®l1 and Understanding of Compliance with UST Requiremen DesigMted UST Operators)for this Facility ' Facility Name:Econo Gas Facility ID#: Facility Address:880 Victor Rd Ream for Submitting this Form(Check One) Lodi,CA p Change of Designated Operator Facility Phone ❑ Update Catititicatc Expiration Date PRIMARY Designated Operator°s Name:Tony Murch Relation to UST Facility(Check One) Business Name(I,f&fferent from above):Franzen-HilI Inc. ❑ Owncr O Operator ❑ Employee ' i Designated Operator's Phone#:(5 59)688-2977 R Service Technician I Third-Party International Code Council Certification#:8008380-UC Expiration Date:2/25/2011 ALTERNATE 1 l7esignated Operator's Name:Terry Hodson Rotation to UST Facility(Check One) Business Name(ffdifferen(frena ahuve):rranzen-still p Owner ❑ Operator ® Employee Designated Operator's Phone#:(559)688-2977 X ScMcc'i:cchnician XThird-Party Intomational Codc Council Ccatifrcattion#:8021463-UC Expiration Date:02/25/2011 ALTERNATE 2 ( Rao Designated Operator's Nance:Steve Zwahlen Relation to UST Facility(Check One) Business Name(!f drferem from above):Framen-Hill ❑ Owner ❑ Operator Cl Employee Designated Operator's Phone#:(559)689-2977 XScmcc Technician XThird-Party International Code Council Certffloatwon#; Expiration Date:03/12/2012 I certify that,for the facility indicated at the top of this gage,the individual(s)listed above will serve as Designated UST Opemtolr(s). The individual(s)will conduct and document monthly facility inspections and annual facility employee ftaining,in accordance with.California Code of Regulations,title 23,section 2715(c)-(f). Furthermore,I understand and am in compliance with the requireMents(statutes, regulations, and local ordinances)applicable to node. y/and storage tanks. NAME OF TANK OWNER se Print): SIGNATURE OF TANK OWNER.- DATE: TaV OWNER'S PHONE#: `6 r a S NOTE: 1)SUBMIT THIS COMPLETED FORM TO THE.LOCAL AGENCY(NOT THE STATE WATER RESOURCES CONTROL.BOARD)BY JANUARY 1,2005.THE LOCAL AGENCY LIST IS AVAILABLE AT:www.waterboards.ca. vat /ustfcontact cava. atrvs.html. 2)NOTIFY THE LOCAL.AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004