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1800 North California Street PR0231036 <br /> September 27, 2021 Program: UST <br /> PHOTO 4: Current Desi nated O erator Identification Form not u loaded to CERS. <br /> Appendix XI <br /> -storage Tank <br /> operator Identification Form <br /> I f• FACI�i'Y�NFrr;_ iVew UST Installation <br /> New/Changetl Desi <br /> gnaletl Operator <br /> Kaci ty tlrFacility Narne <br /> 1800 N CAless_ ST JOSEPHS HOSPITAL <br /> 2. City <br /> STOCKTO. <br /> ^N 952 3ode <br /> Name�i kle9nateda - e <br /> David on the/CC c <br /> Mailingreifica <br /> Atldrestion. <br /> 416 2nd Street s Galt,C ICC Certification <br /> Name of Designated A 95632 8883059•Uc <br /> Zane Nim mo UST Operator Phone <br /> Mailing Address 209.744-0112 <br /> 416 2nd Street Galt,C ICC Certification <br /> Name of Desi <br /> Felix gnated UST 632 8883064.UC <br /> Ramirez Operator Phone <br /> ailing 209.744-0112 <br /> _ 9 Address ICC Certification <br /> 416 2nd Street Galt,CA 95632 8883072 <br /> 'Name of Desi Hated O •UC <br /> Edward'1ea ns UST Operator 209.744-0112 <br /> Mailing A„ a., <br /> 416 2nd Street Gait,CA 9 8883080.UCtion <br /> Name 5per 0•UC <br /> of Designated UST O Phone <br /> AmyWlnkler Operator 209-7q4-0112 <br /> Mailing Address ICC Certification <br /> 416 2nd Street I;alt,CA 95632 9951352-UC <br /> Name of Designated UST O — Phone <br /> Perator - - 209-712-0112 <br /> Mailing Address ICC Certification <br /> Name of Designated UST Operator Phone <br /> MailingAu,,_ - ICC Certification <br /> Name of Designated USTPhone <br /> Open,`ter <br /> Mailing Address ICC Certification <br /> Additional copies of this page ma Phone <br /> y be attached. <br /> CERS=California Environmental Reporting System,ID=Identification,ICC=International Code <br /> Council,UST=Underground Storage Tank <br /> Page 1 of 1 <br /> Lydia Baker, SR. REHS Page 4 of 22 <br />