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Appendix XI <br /> Underground Storage Tank <br /> Designated UST Operator Identification Form <br /> TYPE OF ACTION ❑ New UST Installation © New/Changed Designated Operator <br /> 1. FACILITY INFORMATION <br /> CERS ID Facility Name <br /> 10182093 Tracy Petroleum Inc. <br /> Facilityy Address City ZIP Code <br /> 950 W. 11 th St. Tracy 95376 <br /> 2. DESIGNATED UST OPERATOR INFORMATION <br /> Print names exactly as shown on the ICC certification. <br /> Name of Designated UST Operator ICC Certification <br /> David Winkler 8883059-UC <br /> Mailing Address Phone <br /> 4162nd St Galt CA 95632 209-744-0112 <br /> Name of Designated UST Operator ICC Certification <br /> Zane Nimmo 8883064-UC <br /> Mailing Address Phone <br /> 416 2nd St Galt CA 95632 209-744-0112 <br /> Name of Designated UST Operator ICC Certification <br /> Felix Ramirez 8883072-UC <br /> Mailing Address Phone <br /> 416 2nd St Galt CA 95632 209-744-0112 <br /> Name of Designated UST Operator ICC Certification <br /> Edward Stearns 8883080-UC <br /> Mailing Address Phone <br /> 416 2nd St Galt CA 95632 209-744-0112 <br /> Name of Designated UST Operator ICC Certification <br /> Erik Hinojosa 9209377 <br /> Mailing Address Phone <br /> PO Box 1394, Lafayette, CA 94549 209-744-0112 <br /> Name of Designated UST Operator ICC Certification <br /> Yolanda Thruston 8163784 <br /> Mailing Address Phone <br /> PO Box 1394, Lafayette, CA 94549 888-500-2435 <br /> Name of Designated UST Operator ICC Certification <br /> Marco Alejos 8415074 <br /> Mailing Address Phone <br /> PO Box 1394, Lafayette, CA 94549 888-500-2435 <br /> Name of Designated UST Operator ICC Certification <br /> Nik Zagorov 5264361 <br /> Mailing Address Phone <br /> PO Box 1394, Lafayette, CA 94549 888-500-2435 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, UST = Underground Storage Tank <br /> Page 1 of 1 <br />