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Home My WebLink About4800 FAIRFAX ROAD (3)OCT -13 -2011 10:26 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements P.07 Facility Name: Arco AM PM Facility ID 0: Facility Address: 4800 Fairfax Road Bakersfield, CA 93306 RevAn for Submitting this Form (Check One) Mange of Designated Operator O Update Certificate Expiration DateFacilityPhone #: 661- 835 -8044 Desit? Od UST Oaerator(s) for this Facility PRIMARY Designated Operator's Name: Catherine C. Riocomini Relation to UST Facility (Check One) Owner Operator Employee Service Technician X Third -Party Business Name (Ifdt,(J¢renrfrom above), Confidence UST &7-4ces, Inc. Designated Operator's Phone tt: $00- 339 -9930 International Code Council Certification #: 8018933 -UC Expiration Date: SeptemkT 8, 2012 ALTERNATE I (Okh*m U Designated Operator's Name: Frank I..anda Relation to UST Facility (Check One) Owner operator Employee O Service Technician X Third -Party Business Name (/fdjr&vwfrom above): Ca4Wence UST Seruicet, Inc. Designated Operator's Phone #: 800 - 339 -9930 fnternational Code Council Cetification #: 8018524 -UC Expiration Rate: July 12, 2013 ALTERNATE 2 (Optional) Designated Operator's Name: Sade C. Haake Relation to UST Facility (Check One) Owner Operator Q Employee Service Technician x Third -Party Business Name (& ereatfrom aboue): Co)idenoe USTServices, Inc. Designated Operator's Phone #: 800 -339 -9930 International Code Council Certification p: 8080418 -UC Expiration Date: September 15, 2012 I certify that, for the facility indicated at the top ofthis page, the individuals) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f), Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tagks. NAME OF TANK OWNER (Please Print): SIGNATURE OF TANK OWNER: DATE: _ 17— ,2Q-' OWNER'S PHONE#; to t— F3 -- ?AqqSW NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) I THE LOCAL AGENCY LIST IS AVAILABLE AT- )yNm. waterboarda .oa.eovJu$dcontacts/OM eevs.htrni. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 OCT -13 -2011 10:26 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements P.08 Facility Name: Arco AM PM Facility ID #: Facility Address: 4800 Fairfiax Road Bakersfield, CA 93306 Reason for Submitting this Form (Check One) Change of Designated Opemr Update Certificate Expiration DateFacility.Phone #: 661- 835.8044 Desigggteed UST Oioerator(sl for this Facility Alternate 3 (Optional Designated Operator's Namc: Edward Mitchell Relation to UST Facility (Check One) Owner Operator Employee Service Technician X Third -Party Business Name (IfdI erenrfrom above): Coodence UST SsrWces, Inc. Designated Operator's Phone #: 800- 339 -9930 International Code Council CartiScation #: 5758845 -UC Expiration bate: February 17, 2012 ALTERNATE 4 (OpdonaD Designated Operator's Name: Bryan A Self Relation to UST Facility (Check one) Owner Operator Employee Service Technician X Third -parry Business Namc ({f & erentfrom above): Co4idence UST SeMces, Inc. Designated Operator's Phone #: 800 - 339 -9930 International Code Council Certification #: 8022804•UC Expiration Date: November 19, 2012 ALTERNATE S (Optionso Designated Operator's Name: Kristopher M, Karns Relation to UST Facility (Check One) Owner Operator Employee Service Technician x Third•Party Business Name (ffdijlere alfrom above) :.CoVidence UST.Y"ces, Inc. Designated Operator's Phone #: 800- 339 -9930 International Code Council Certification #: 5264406•UC Expiration Date: July 19, 2013 I certify that, for the facility indicated at the top ofthis 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) - (fl. Furthermore, l understand and am In compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please SIGNATURE OF TANK OWNER: DATE: I "! OWNER'S PHONE fl: 44 —f J '0( NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) `YHE LOCAL AGENCY LIST IS AVAILABLE AT: wvw. waterbaards ,ca.goy /u$t /contaots/cuna a&%hMI. 2) NOTIFY THE LOCAL AGENCY OF ANY CiIANGES TO TM INFORMATION WTTHIN 30 DAYS OF THE CHANGE. Novcmber 2004 OCT -13 -2011 10:27 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements P.09 Facility Name: Arco AM P.M Facility ID #: Facility Address: 4800 Fairfax Road Bakersfield, CA 93306 Reason for Submitting this Form (Check One) Change of Designated Operator UpdatcCatificate Expiration DateFacilityPhone #: 661 -835 -8044 Desinmated UST Operators) for this Facili,V Alternate 6 ne Designated Operator's Name: Douglas M. Young Relation to UST Facility (Check One) Owner Operator Employee Service Technician x Third -Parry Business Name (Ifdlfferentfrom above): Confidence UST Saucet. J= Designated Operator's Phone #: 800 - 339.9930 international Code Council Certification #: 0878646 -UC Expiration Date: September 8, 2012 ALTERNATE 7 (Optional) Designated operator's Name: Relation to UST Facility (Check One) Owner Operator Employee Service Technician Third -Party Business Name (# &fferenr from above): Desigaated Operator's Phone #: Inwinational Code Council Cuni6cation #; Expiration Date: ALTERNATE 8 (Optloruat) Designated Operator's Name: Relation to UST Facility (Check One) Owner Operator Employee Service Technician Third -Party Business Name (ffdifferentfrom above):. Designated Operator's Phone #: international Code Council Certification #: Expiration pate: I certify that, for the facility indicated at the top ofthis 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, l understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please Print): SIGNATURE OF TANK OWNER: r / UI / ` DATE: J OWNER'S PHONE #: Du-g'l% NOTE: 1) SUBN M THIS COMPLETIM FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) THE LOCAL AGENCY LIST IS AVAILABLE AT: www. waterboards .ca.pov /uk /contacts/cuoa aeyy.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INIMRMATION WMIN 30 DAYS OF THE CHANGE. November 2004 p01DFti v n 0a NV10ES %+ COMPLIANCE WITH CONFIDENCE" October 26, 2011 CITY OF BAKERSFIELD Fire Prevention Services 2101 -H- Street Bakersfield, CA 93301 To Whom It May Concern: Enclosed please find completed Owner Statements of Designated UST Operator and Understanding of and Compliance with UST Requirements re Change of Designated Operator for Arco AM PM's (F Street, Fairfax Road, Monterey Street) and HP Go Go's Wilson Road and Wible Road). Please feel free to contact me should you have any questions. Thank you. Enclosures CONFIDENCE UST SERVICES, INC. okQ. ( XL- Cheri Young, ce- " L 16250 Meacham Road • Bakersfield, CA 93314 661) 631 -3870 or (800) 339 -9930 FAX (661) 587 -9758