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From: Franzen-H0 To: 12094683433 Page: 516 Date:J&2013 4:49:00 PM <br /> Owner Statements of Designated Underground Storage Tank P8e <br /> D <br /> and Understanding of Compliance with UST Requirements <br /> Desig_naLe_d UST ORerator(s)for this Facifily <br /> 0 8 2013 <br /> SNIVIn <br /> Facility <br /> Faciliy ID E <br /> HEA E0A.,.1YTA <br /> Facility Address: Reason for Submitting this Form ojheXbaj <br /> vl() 11 Change of Designated Operator <br /> 1.Facility Phone:( <br /> 0 Update Certificate Expiration Date <br /> PRIMARY <br /> Designated Operator's Name:Lyle Meeks Relation to UST Facility(Check One) <br /> Business Name(1fdifferentfrom above):Franzen-Hill Inc. 0 Owner 13 Operator 11 Employee <br /> Designated Operator's Phone fi-,(559) 805-3367 X Service Technician X Third-Party <br /> -International Code CouncitCertification#: 8188753-UC Expiration Date:01/18/2015 <br /> ALTERNATE I(Optional) - - <br /> Designated Operator's Name:James Flowers Relation to UST Facility(Check One) <br /> ---- ------ <br /> Business Name(1fdIfferentfrom above).-Franzen-Hill El Owner C3 Operator 0 Employee <br /> Designated Operator's Phone#:(559)972-5087 08ervice Technician OThird-Farty <br /> International Code Council Certification#:8036233-UC Expiration Date:01/12/2015 <br /> ALTERNATE 2 (Optional) <br /> Designated Operator's Name:Adam Taylor Relation to UST Facility(Check One) <br /> Business Name(If different from above):Franzen-Hill 0 Owner 0 Operator 0 Employee <br /> Designated Operator's Phone#.(559)688-2977 ElSorvice Technician OThird-Party <br /> International Code Council Certification#:8143455-UC Expiration Date;01/02/12015 <br /> I certify that,for the facility indicated at the top of this page,the individual(s)listed above will <br /> serve as Designated UST Operator(s). The individual(s)will conduct and document monthlyei <br /> facility inspections and annual-facility employee training, in accordance with California Code of <br /> Regulations,title 23, section 2715(c)-(f). <br /> Furthermore,I understand and am in compliance with the requirements(statutes, <br /> regulations, and local ordinances) applicable to underground storage tanks. <br /> NAME OF TANK OWNER(Please Print): <br /> SIGNATURE OF TANK OWNER: <br /> DATE: 2, 3 OWNER'S PHONE#: <br /> NOTE- 1)SUBMIT THIS COMPLETED FORM TO THE,LOCAL AGENCY(NOT THE STATE WATER <br /> RESOURCES CONTROL BOARD)BY JANUARY 1,2005,THE LOCAL AGENCY LIST IS AVAILABLE <br /> AT., www.waterboard5,. <br /> 2)NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS <br /> OF THE CHANGE. <br /> November 2004 <br /> This fax was sent with GF1 FAXmaker fax server.For more information,visit: http://www.gfi.com <br />