COMPLIANCE INFO_2002-2005 - Laserfiche WebLink

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by 00 � BP West Coast Products LLC 4 Centerpointe Drive La Palma,CA 90623 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of Compliance with UST Requirements Facility Name:ARCO—5450 Facility ID#: Facility Address: 1617 W FREEMONT Reason for Submitting this Form(Check One) STOCKTON,CA 95203 X Change of Designated Operator Facility Phone#:209-462-1617 ❑ Update Certificate Expiration Date Designated UST Operator(s) for this Facility PRIMARY Designated Operator's Name:Alfred Reali Relation to UST Facility(Check One) Business Name(If different from above):ARCO Franchise Dealer ❑ Owner X Operator ❑ Employee Designated Operator's Phone#:209-462-1617 ❑ Service Technician ❑ Third-Party International Code Council Certification#: Temporary Expiration Date: 12/19/2006 ALTERNATE 1 (Optional) Designated Operator's Name:refer to backup document Relation to UST Facility(Check One) Business Name(If different from above):Delta Environmental Consultants, ❑ Owner ❑ Operator El Employee Inc. Designated Operator's Phone#:refer to backup document ❑ Service Technician X Third-Party International Code Council Certification#:refer to backup document Expiration Date:refer to backup document ALTERNATE 2 (Optional) Designated Operator's Name:refer to backup document Relation to UST Facility(Check One) Business Name(If different from above):refer to backup document ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:refer to backup document ❑ Service Technician X Third-Parry International Code Council Certification#:refer to backup document Expiration Date:refer to backup document 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 2715(c) - (f). Name of tank Owner (print): Chriiss�Moul Signature of Tank Owner: L.,. � Date: 12/22/2004 Owner's Phone # (714) 690-2349 In December 2004,BP West Coast Products,LLC submitted a separate letter to the local agencies documenting compliance with UST regulations. A copy of this letter can be made available upon request.