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HomeMy WebLinkAbout9600 BRIMHALL ROAD (4)Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: 7 -11 32376 Facility ID #: 32376 Facility Address: 9600 Brimhall Rd. Bakersfield, CA 93312 Reason for Submitting this Form (Check One) Change of Designated Operator Update Certificate Expiration DateFacilityPhone #: (661)588 -4059 Designated UST Operator(s) for this Facility PRIMARY Designated Operator's Name: Justin Downs Relation to UST Facility (Check One) Owner Operator Employee Service Technician ® Third -Party Business Name (Ifdifferent from above): Belshire Environmental Services, Inc. Designated Operator's Phone #: (949) 460 -5200 Intemational Code Council Certification #: 8021990 -UC Expiration Date: 1217/2012 ALTERNATE 1 (Optional) Designated Operator's Name: refer to the backup document Relation to UST Facility (Check One) Owner Operator Employee Service Technician ® Third -Party Business Name (Ifdifferent from above): refer to the backup document Designated Operator's Phone #: refer to the backup document International Code Council Certification #: refer to the backup document Expiration Date: refer to the backup document ALTERNATE 2 (Optionao Designated Operator's Name: refer to the backup document Relation to UST Facility (Check One) Owner Operator Employee Service Technician ® Third -Party Business Name (Ifdifferent from above): refer to the backup document Designated Operator's Phone #: refer to the backup document International Code Council Certification #: referto the backup document Expiration Date: refer to the 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 (Please Print):. Stephen K. Boyd SIGNATURE OF TANK OWNER: .C6*1. DATE: 5/11/2011 OWNER'S PHONE #: (714) 674 -4292 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 .ca.gov /ust/contacts /cupa agys.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TOT IS+INFORMAT,ILON WITHIN 30 DAYS OF THE CHANGE.- M AY 1 2011 November 2004 S7R%1ICES beishi're environmental services, inc. 25971 Towne Centre Drive, Foothill Ranch, CA 92610 Designated Operator Alternate List N e IC Ce Faepiratinn Phq.ne _ Jhustin Abeleda 8036229 -UC 9/26/20.11 I 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 9/812012 949) 460 -5200 Cheron Flores 8019649 -UC 10/8/2012 949) 460 -5200 Grasiela Gama 8022001 -UC 12/14/2012 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