HomeMy WebLinkAbout6601 MING AVENUE (3)Nw°1.
City of Bakersfield Fire Dept. Prevention Services
Owner Statement of Designated Underground Storage Tank(UST) Operator and
understanding of Compliance with UST Requirement
Facility Name: Chevron Station# 201527
Facility Address : 6601 MING AVE,
BAKERSFIELD, CA, 93309 -3446
Facility Phone# : () 661 - 8311270
PRIMARY
Facility ID: 3186
Reason for Submitting this Form (Check One)
Change of Designated Operator
Update Certificate Expiration Date
Q Initial Submittal Of Designated Operator
DESIGNATED UST OPERATORS FOR THIS FACILITY
Designated Operator's Name : Maurice Tamamian Relation to UST Facility (Check One)
Owner =Operator mpioyee
E]service Technician Third -Party
Expiration Date : 9/29/2012
Business Name (If different from above) : Chevron Products Company
Designated Operator's Phone # : (925) 842 -9002
International Code Council Certification # : 8041099 -UC
ALTERNATEI (Optional)
Designated Operator's Name: Chevron Designated Operators Relation to UST Facility (Check One)
Dwner [::]Dperator mpioyee
Oervice Technician Third -Party
Expiration Date: 11/24/2011
Business Name (If different from above) : Chevron Products Company
Designated Operator's Phone # : (925) 842 -9002
International Code Council Certification #: Chevron Addendum
ALTERNATE2(Optional)
Designated Operator's Name : Relation to UST Facility (Check One)
ElOwner Eoperator [::mployee
Elservice Technician Third -Party
Expiration Date :
Business Name (If different from above)
Designated Operator's Phone # : () -
International Code Council Certification # :
NOTE: THE LOCAL REGULATORY AGENCY MUST BE NOTIFIED OF ANY CHANGES TO THIS INFORMATION
WITHIN 30 DAYS OF THE CHANGE
I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as the 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 THE TANK OWNER
OR OWNER'S AGENT (Please Print) :
SIGNATURE OF TANK OWNER
OR OWNER'S AGENT (Please Print) :
Chevron product Company, Attn: Permit Desk
DATE: 12/3/2010 OWNER'S PHONE #: (925)842 -9002
I
Vw
Chevron Employee Designated Operator Addendum
Chevron Designated
Operator Name Phone Number ICC Certificate #
ICC Expiration
Date
Adel Amarin 909 767 -0588 8032306 -UC 10/21/2011
Edward Dahl ren 916 271 -2363 8016980 -UC 9/28/2012
Eli'a Pender raft 916 728 -1850 8033585 -UC 8/6/2011
Hady Hernandez 323 547 -0104 8041099 -UC 11/10/2011
Jan Koekkoek 760 201 -3957 8016991 -UC 817/2012
Jeremy Glick 916 985 -4471 8020701 -UC 7/2/2011
John Dale 916 217 -1373 8000863 -UC 11/24/2011
Janet Mc CI monds 925 842 -3888 5242606 -UC 3/31/2012
Maurice Tamamian 818 430 -0655 5250201 -UC 9/29/2012
Pauline S Calalan 707 315 -4737 5256925 -UC 12/5/2011
Rodne Boles Muse 909 534 -1589 5292549 -UC 1/30/2012
Michael Wilkinson 707 257 -1224 5296380 -UC 3/31/2012
Chevron Designated Operator Addendum 12- 1- 2010.xls Page 1
u
Chevron Products Company
Marketing HES Permits
PO Box 6004, 1-2375 -133
San Ramon, CA 94583
Tel 925 - 842 -9002
Fax 925 - 842 -9585
cbittle@chevrontexaco.com
December 07, 2010
City of Bakersfield Fire Dept. Prevention Services
1500 Truxtun Ave
Bakersfield, CA, 93301
Charles Bittle
HES Permits
Re: Chevron Products Company Owner Statement of UST Designated Operator
In accordance with California Code of Regulations, title 23, section 2715(c) - (f), enclosed are the following
documents:
Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and
Compliance with UST Requirements
These documents meet the compliance requirements for all UST systems owned by Chevron Products
Company on behalf of our station operators. If you have any questions contact the Chevron Products
Company Marketing HES Permit Desk at 925 - 842 -9002. .
Sincerely,
Chevron Products Company, HES Permits
Charles Bittle
Enclosures
Cc: Chevron Station Operators
Chevron