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RE <br /> C . <br /> J, 201 , <br /> Owner Statements of Designated Underground Storage Tank(UST) Oper <br /> and Understanding of and'Compli `��6iwith UST Requirements _ <br /> FacilityName: Corp--Yard Facility ID#: <br /> Facility Address: Reason for Submitting this Form(Check Orae) <br /> 1465 S. Lincoln Street Stockton CA 95206 Change of Designated Operator <br /> Facility Phone# 209 937-8453 X Update Certificate Expiration Date <br /> Desiggated U T Operator(s)for this Facility <br /> PRIMARY <br /> Designated Operator's Name:Karen R Ambit Relation to UST Facility(Check One) <br /> Business Name(Ifdi ergine from above): a Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:(209 518-4536 ❑ Service Technician X Third-Party <br /> International Code Council Certification#:$356759 Expiration Date:03/30/2019 <br /> ALTERNATE 1 loam! <br /> Designated Operator's Name. Relation to UST Facility(Check One) <br /> Business Name(If diereru'fromabove): ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: ❑ Service Technician ❑ Third-Party <br /> #International Code Council Certification#: Expiration Date: <br /> ALTERNATE 2 ((Optional) <br /> Designated Operator's N Relation to LIST Facility(Check One) <br /> Business Name(!fdfflerenl from above):,, Q Owner ❑ Oporawr a Employee <br /> tN,itmeted Onemtor'e Phone#: ❑ Service Technician ❑ Third-Party <br /> ,e: <br /> a <br /> v <br /> fa,.',TrjTV .L(, � 1(s <br /> M <br /> �F ate a 1 <br /> rai ted U <br /> t <br /> :.'y¢y�jg�, '�'E9e gT� tri x 3 ti i" -S• t, v i,,,x " '" ,q 3.cnl " ,. ._art [ <br /> 4se $a.;, 3: .. a a ».. <br /> a .. <br /> ?�y nri; 4Ji`: .. cin ;fit; ;4II'.I 4 ? Sa <br /> ,IJ -Opp", v, A fiat+ nata l ' .r "r + :.' <br /> EEE <br /> VS, 6, ' C <br /> .- .,. ,.. ,.. „�,,...Ste.•-: ,_. - 3 i <br /> f <br /> b r <br /> '{ <br /> IV t. <br /> 4 <br /> I( TI r <br /> p� <br /> ` a6, k`"',.� ` .t. ��� ..�, ..i PS^'aF 1.. .- <br /> $` om. <br /> :�,�,���+�€.•.�d{' .r�� lr�} .��, .e�`,:v°.�� a..dl,. ,. �T tr .�..,, ,k ;k`t s �v ' �y` a�a w }.Ta §'r "e¢�Ry, `'i•$%.. <br />