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Home My WebLink About3301 WIBLE ROAD (4)OCT -13 -2011 10:25 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements P.02 Facility Name: HP Go Go Mini Mart Facility ID #: Facility Address: 3301 Wible Road Bakersfield, CA 93309 Reason for Submitting this Form (Check Aire) Change of Designated Operator Update Certificate Expiration DateFacilityPhone #: 661 - 3974553 Designated UST Operator(p) for this Faciltty PRIMARY Designated Operator's Name: Catherine C. Riocomini Relation to UST Facility (Check One) Owner 0 Opp Employee 0 Service Technician X Third -Party Business Name (?f diffmntfrom above).- Confidence UST SerWcar, Inc. Designated Operator's Phone #; 800.339 -9930 International Code Council Certification ti: 8018933 -UC Expiration Date: September 8, 2012 ALTERNATE I nW) Designated Operator's Name: Frank L:,anda Relation to UST Facility (Check One) Owner Operator O Employee Service Technician X Third -Party Business Name (Ifd(fferew from above): Cnig?dence UST &r%icer, lne, Dcaignated Operator's Phone b: 800 - 339 -9930 International Code Council Certification #: 8018524 -UC Expiration Date: July 12, 2013 ALTERNATE 2 (Opdoaai') Designated Operator's Name: Sade C. Haske Relation to UST Facility (Check One) i5 Owner Operator Em1kryee Service Technician x Third -Patty Business Name (/fd(ferentfrom above): Confidence USTSen.(ces. Inc-, Designated Operator's Phme #: 800.339 -9930 International Code Council Certification #: 8080418 -UC Expiration Date: September 15, 2012 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, I understand and am in compliance with the requirements (statutes, regulations, and Iocal ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please SIGNATURE OF TANK OWNER: DATE: j u OWNER'S PHONE #: /-- AjJ/ NOTE: 1) SUBMIT THUS COMPLETED FORM TO THE LOCAL AGENCY (NOT TILE STATE WATER RESOURCES CONTROL BOARD) . THE LOCAL AGENCY LIST IS AVAILABLE AT: www.)nterboards,ca.gov/ust/contAguicupA g0m html, 2) NOTU Y THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WrrHIN 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.03 Facility Name: HP Go Go Mini Mart Facility 10 #: Facility Address: 3301 Wible Road Bakersfield, CA 93309 Reason for Submitting this Form (Check One) Change of Designated Operator Update Certificate Expiration DateFacilityPhouo #: 661 - 397 -4553 Desla&ted UST Oaerator(s) %r this FaciilfEv, ALTERNATE 3 (Optional Designated Operator's Name: Edward Mitchell Relation to UST Facility (Check One) Owner Operator Employee Service Technician X Third -Party Business Name (Ifdijjerenifrom above): Confidence USTServices. Inc. Designated Operator's Phone #: 800-339 -9930 Intemationai Code Council Ccttificatioo #: 5258845 -UC Expiration Date: February 17, 2012 ALTERNATE 4 (OoNoaaD Dcsigtrated Operator's Name: Bryan A Self Relation to UST Facility (Check One) Owner Operator Employee Service Technician X Third -Party Business Name (ifd48erentfivm above): ComUerce UST &r -Wces, inc. Designated Operator's Phone #: 800-339 -9930 Intemational Code Council Certification #: 8022804 -UC Expiration Dace: November 19, 2012 ALTERNATE 5 (Option() Designated tutor's Name: Kristopher M. Karns Relation to UST Facility (Check One) Owncr Ope rUtor Employee savioe Technician x Third -Fany Business Name (Ifdi emmnifrom above).. Coodence U5TServices. Inc. Designated Operator's Phone #: 800- 339 -9930 1nt¢rnadonal 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) - (0. Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Pleaue SIGNATURE OF TANK OWNER DATE: OWNER'S PHONE #-- . a m 7 q NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterbmds.ca.govLr&t /-mu;ts /cup§ aays.html. 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 ofand Compliance with UST Requirements P.04 Facility Name: HP Go Go Mini Mali Facility ID #: Facility Address: 3301 Wible Road Bakersfield, CA 93309 Reason for Submitting this Form (Check One) lE Change of Designated Operator UpdateCertificate Fxpiratinn DateFacilityPhone #: 661- 3974553 Deslimated UST Operator(s) for this Facility ALTERNATE 6 (Optional? Designated Operator's Name: Douglas M. Young Relation to USTFacility (Check One) Owns' O Operator Employee Service Technician X Third -Party Business Name (Ifdi,$ematfrom above): Cpnftdence USTSen4eev, Inc, Designated Operator's Phone #: 800-339 -9930 International Code Council Certification #: 0878646 -UC Expiration pate: Scptember 8, 2012 ALTERNATE 7 (OnUonab Designated Operator's Name: Relation to UST Facility (Check One) Owner O Oporatar D Employee U Servicc Technician Tbird -Party Business Name (Q'dfgemntfmm above). Designated Operator's Phone p: Intmationai Code Council Certification #: Expiration Date: ALTERNATE 8 (OptlonaQ Designated Operator's Name: Rclation to UST Facility (Check one) O Owner Operator Employee Service Technician O Third-Party Business Name (O d(fferenlfrom above),. Designated Operator's Phone #: International Code Council Certification #: Expiration Date: I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s), The individuals) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (.fl. Furthermore, I understand and amt In compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please SIGNATURE OF TANK OWNER: DATE: —' — _ OWNER'S PHONE #: && l.- r3 rNy NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) THE LOCAL AGENCY LIST IS AVAILABLE AT: www waterboardsca govlusticontacts/cupa agy$htMl. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 4U ST 104rE' 701W Invoice No.: 28846 Site: HP Go Go 3301 Wible Road Bakersfield, CA 93309 Repairs Requested: Verify replacement & Operation of Pump Sensor Module. Repairs completed: Verify replacement & Operation of Pump Sensor Module. On 2/10/2012 1 was scheduled with the Bakersfield Fire Department to verify the replacement and operation of the Pump Sensor Module that was installed. However on this date we were unable to verify the proper operation of the Pump Sensor Module due to wiring issues. These wiring issues were resolved on 2/13/2012 with the help of Sunset Mechanical, but we were unable to verify the proper operation of the module because the Regular South Sub Motor will not turn on due to a burnt out Turbine that needs to be replaced in order to properly verify the operation. Required Repairs, Still Pending: The Unleaded South Turbine will need to be replaced in order to properly verify the operation of the Pump Sensor Module with the Bakersfield Fire Department. Technician Name: Kristopher Karns Signature: ,_k A Date: 2/13/2012