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From: Franzen-Hill Inc. To: 12094683433 Page:616 Date: 3/8/2013 4:49:00 PM RECEIVED (i Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of Compliance with UST Requirements MAR 0 8 2013 Designated UST Operator(s) for this Facility ENVIRONMENTAL NT Facility Name: 6",co 0 0 c,LS Facility ID#;JI HEMTH—LjF—_rWX—ff I'ViL Facility Address: Reason for Submitting this Form(Clieck One) fL,?Q V,�C,*Wr rLead Cok),� G Z Q 0,Change of Designated Operator Facility P1 0 Update Certificate Expiration Date PRIMARY Designated Operator's Name;Lyle Meeks Relation to UST Facility(Check One) Business Name(1fdifferent from above):Franzen-Hill Inc. C3 Owner 0 Operator 0 Employco Designated Operator's Phone#:(5 59) 805-3367 X Service Technician X Third-Party International Code Council certification#;8188753-UC Expiration Date:01/18/2015 ALTERNATE-1 jnpdqnf!1 Designated Operator's Name:James flowers Relation to UST Facility(Check One) from above).,Franzen-Hill Business Name(Ydifferent fi 0 Owner 13 Operator 0 Employee Designated Operator's Phone#:(559)972-5097 oService Technician OThird-Party International Code Council Certification#:8036233-UC Expiration Date:01/12/2015 ALTERNATE 2 (Optional) Designated Operator's Name:Adam Taylor Relation to UST Facility(Check-One) Business Name(If differentfrom above):Franzen-Hill 0 Owner 0 Operator C1 Employee (559)688-2977 M, uService Technician 0ThitdPa Designated Operator's Phone i. International Code Council Ceftificationg:8143455-UC Expiration Date:01/02//2015 I certify that, for the facility indicated at the top of this page,the individual(s) listed above will serve as Designated UST Operator(s). The individual(s)will conduct and document monthly facility inspections and annual facility employee training,in accordance with California Code of Regulations,title 23,section 2'715(c)-(f). Furthermore,I understand and am in compliance with the requirements(statutes, regulations,and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER(Please Print),_.... SIGNATURE OF TANK OWNER:.. DATE: OWNER'S PHONE M NOTE: 1)SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY(NOT THE STATE WATER RESOURCES CONTROL BOARD)BY JANUARY 1,206.THE LOCAL AGENCY LIST IS AVAILABLE AT: Avw.w&tMb agys.bmil. 2)NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 This fax was sent with GFI FAXmaker fax server. For more information,visit: http://www.gfi.com