COMPLIANCE INFO_2003-2005 - Laserfiche WebLink

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by0• �i 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: 6347 Facility ID#: 6347 Facility Address: 2430 JOE POMBO PKWY TRACY CA 95376 Reason for Submitting this Form(Check One) Facility Phone#:209-830-8142 X Change of Designated Operator ❑ Update Certificate Expiration Date Designated UST Operators) for this Facility PRIMARY Designated Operator's Name:Brian Ellsworth Relation to UST Facility(Check One) Business Name(If different from above):Delta Environmental Consultants,Inc. ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:916-524-6974 ❑ Service Technician X Third-Party International Code Council Certification#: 5263224-UC Expiration Date:2007-07-07 00:00:00 ALTERNATE 1 (Optional) Designated Operator's Name:refer to backup document Relation to UST Facility(Check One) Business Name(If different from above): ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:refer to backup document ❑ Service Technician X Third-Party International Code Council Certification#:refer to backup document --TExpiration 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): ❑ Owner ❑ Operator ❑ Employee 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 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): Chris Moul Signature of Tank Owner: z;L..., Date: 8/30/2005 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.