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UNDERGROUND STORAGE TANK <br /> STATEMENT OF UNDERSTANDING AND COMPLIANCE FORM (Page 1 of 1) <br /> Every underground storage tank (UST)facility must submit a one-time statement indicating that the owner or operator <br /> understands and is in compliance with all applicable UST requirements. A copy of this completed form must be submitted <br /> via either the California Environmental Reporting System(CERS)or an equivalent local Unified Program Agency electronic <br /> reporting portal within 30 days of: 1)an installation of a UST;or 2)a change in owner or operator of the UST,as applicable. <br /> [California Code of Regulations,Title 23,Division 3,Chapter 16,Section 2715(a).l <br /> Type of Action <br /> ❑New Installation 'Change of Ownership ®Change of Operator <br /> I. FACILITY INFORMATION <br /> Business Name(Same as Facility Name or DBA-❑ofng Business As) CERS ID <br /> Tracy Blvd Shell 10181411 <br /> Bucinass Site Address city ZIP Code <br /> 3725 N. Tracy Blvd. Tracy 195304 <br /> 11. OWNER J OPERATOR INFORMATION <br /> Relationship to Underground Storage Tank(S) x❑ Owner ❑ Operator <br /> UST Owner 1 Operator Name Phone# <br /> RADC Enterprises, Inc. (909) 394-4728 <br /> Mailing Address City State ZIP Code <br /> 1450 N. Benson Ave, Suite A [Upland CA 191786 <br /> III. CERTIFICATION BY OWNER/OPERATOR OF UNDERSTANDING AND COMPLIANCE <br /> I hereby certify that I understand the underground storage tank requirements of Health and Safety Code, Division 20, <br /> Chapter 6.7,California Code of Regulations;Title 23,Division 3,Chapter 16;and any applicable local underground storage <br /> tank ordinances and that the facility identified above is in compliance with all applicable underground storage tank <br /> requirements. <br /> UST Owner/Operator Slgnalur Date <br /> 1/2/2019 <br /> ID=Identification <br />