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Jul 30 10 12:10p Rfforda Test (209) 744-0116 P.1 <br />`., . <br />l <br />4162 "d Street Phone: (209) 744-0112 c� <br />Galt, Ca 95632 Fax: (209) 744-0116 <br />affords softeorn.net <br />Owner Statements of Designated Underground Storage Tank Operator <br />and Understanding of and Compliance with UST Requirements <br />Facility Name: Ace Tomato Inc Facility #: <br />Address: 2771 E French. CampFrench CampCA <br />Facility Picone #: ❑ Change of Designated Operator <br />Q New Designated Operator <br />DESIGNATED UST OPERATOR FOR THIS FACILITY: <br />PRIMARY <br />Designated Operator's Name: ZANE NIMMO Service Technician <br />Business Name: AFFORDA TEST ICC #: 5263322 -UC <br />Designated Operator's Phone: 209-744-0112 Expiration Date: 312112 <br />ALTERNATEI <br />Designated Operator's Name: FELIX RAMIREZ Service Technician <br />Business Name: AFFORDA TEST ICC ': 52733934 -UC <br />Designated Operator's Phone: 209-744-0112 Expiration Date: 4/7i 12 <br />ALTERNATE2 <br />Designated Operator's Name: DAVIDWINKLER Service Technician <br />Business Name: AFFORDA TEST ICC #: 5263373 -UC <br />Designated Operator's Phone: 209-744-0112 Expiration Date: 3124112 <br />ALTERNATE3 <br />.t-- <br />Designated Operator's Name: LYLE NIMMO SexviceTeclinician <br />Business Name: AFFORDA TEST ICC #: 5249115 -UC <br />Designatcd Operator's Phone: 209-744-01[2 Expiration Date: 2/24/12 <br />1 certiry that, for the facility indicated at the top of this page, the individuals listed above will serve as Designated UST <br />Operators. The individuals will conduct and document monthly facility inspections and annual facility employee training, in <br />Accordance with California Code of Regulations, title 23, section 2715 (c) — (f). <br />Furthermore, 1 understand and am in compliance with the requirements (statutes, regulations, and local <br />Ordinances) applicable to underground storage tanks. <br />NAME OF TANK OWNER (Print): '�� r . <br />SIGNATURE OF TANK OWNER: Win! <br />DATE: A� v OWNS S PHONE: <br />NOTE: <br />I) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT SWRCB) AFTER SIGNING. THE LOCAL AGENCY <br />LIST IS AVAILABLE AT: wwww waterboards ca L*oy/ust/contacts/cuna Ms html. <br />2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. <br />OFFICE. <br />County: Date Faxed: Date Scanned: <br />