HomeMy WebLinkAboutDESIGNATED UST OPERATOR 12/7/2012Owner Statements of Designated Underground Storage Tank (UST) Operator
and Understanding of and Compliance with UST Requirements
Facility Name: BP 01960 Facility ID: 01960
Facility Address: 1701 BRUNDAGE LANE Reason for Submitting this Form (Check One)
BAKERSFIELD , CA 93304 Change of Designated Operator
Updated Certificate Expiration DateFacilityPhone #: 6613227213
Designated UST Operator(s) for this Facility
PRIMARY
Designated Operator's Name: Justin Downs Relation to the UST Facility (Check One)
Owner Operator Employee
Service Technician Third -Party
Business Name (If different from above): Belshire Environmental Services, Inc.
Designated Operator's Phone #: (949) 460 -5200
International Code Council Certification #: 8021990 -UC Expiration Date: 1217/2012
ALTERNATEI
Designated Operator's Name: refer to backup document Relation to the UST Facility (Check One)
Owner Operator Employee
Service Technician w Third -Party
Business Name (If different from above): refer to backup document
Designated Operator's Phone #: refer to backup document
International Code Council Certification* refer to backup document Expiration Date: refer to backup document
ALTERNATE
Designated Operator's Name: refer to backup document Relation to the UST Facility (Check One)
Owner Operator Employee
Service Technician Third -Party
Business Name (If different from above): refer to backup document
Designated Operator's Phone #: refer to backup document
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).
Furthermore, I understand and am in compliance with the requirements (statutes, regulations,
and local ordinances) applicable to underground storage tanks.
Name of Tank Owner (print): Rich Gossett
Signature of Tank Owner: M AY 1 2011
Date: 5/10/2011 Owner's Phone #: (714) 670 -3958 „LTFI Sri
NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY
JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ra.gov /ust/contacts /cupa_agys.html.
2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE.
helshire
environmental services, inc.
25971 Towne Centre Drive, Foothill Ranch, CA 92610
Designated Operator Alternate List
Name "
IVMI'--
MM-2 W-W-1 atl 0- MitM
Jhustin Abeleda 8036229-UC 9/26/2011 949) 460-5200
Jeffrey Badders 5252456-UC 10/19/2011 949) 460-5200
Adam Burton 8049062-UC 12/8/2011 949) 460-5200
Oliver Cruz 5244318-UC 9/8/2012 949) 460-5200
Andy DeGregorio 8019630-UC 10/4/2012 949) 460-5200
Ricky Diaz 8102023-UC 2/15/2013 949) 460-5200
Jesse Diaz 8035355-UC 9/4/2011 949) 460-5200
Jackie Dougherty 5234433-UC 7/14/2012 949) 460-5200
Justin Downs 8021990-UC 12/7/2012 949) 460-5200
Glenda Esteban 8018547-UC 9/8/2012 5200
Cheron Flores 8019649-UC 10/8/2012 949) 460-5200
Grasiela Gama 8022001-UC 12/14/2012 —F(949) 460-5200
Angelo Georgetti 8027546-UC 3/22/2013 949) 460-5200
Anthony Greco 8008443-UC 3/17/2012 949) 460-5200
Noah Henning 8013041-UC 5/26/2012 949) 460-5200
Brian Hernandez 5308636-UC 2/15/2013 949) 460-5200
Kevin Hom 8054461-UC 1/22/2012 949) 460-5200
Santi Luangpraseut 8057544-UC 2/11/2012 949) 460-5200
Jack Nestler 8079218-UC 8/31/2012 949) 460-5200
Cory Nicholson 8020120-UC 10/8/2012 949) 460-5200
Chukwuemeka Odunze 8105942-UC 3/18/2013 949) 460-5200
Clarinda Olson -----5244506-UC 2/2/2013 949) 460-5200
Cristina Pena 8010939-UC 5/15/2012 949) 460 -5200
Spencer Platler 8014664-UC 6/16/2012 949) 460-5200
Douglas Shearer 5240897-UC 7/14/2012 949) 460-5200
Roman Shekhter 8035361-UC 9/9/2011 949) 460-5200
Greg Vierra 5317332-UC 7/22/2011 949) 460-5200