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Home My WebLink About928 FLOWER STREET (2)Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Flower Street Mini Mart Facility ID #: Facility Address: 928 Flower Street Bakersfield, CA 93305 Reason for Submitting this Form (Check One) x Change of Designated Operator Update Certificate Expiration DateFacilityPhone #: (661) 328 -0732 Designated UST Operator(s) for this Facility PRIMARY Designated Operator's Name: Catherine C. Riccomini Relation to UST Facility (Check One) Owner Operator Employee Service Technician X Third -Party Business Name (Ifdifferentfrom above): Confidence UST Services, inc. Designated Operator's Phone #: 800 - 339 -9930 International Code Council Certification #: 8018933 -UC Expiration Date: September 8, 2012 ALTERNATE 1 (Optional) Designated Operator's Name: Frank Landa Relation to UST Facility (Check One) Owner Operator Employee Service Technician X Third -Party Business Name (ifdifferentfrom above): Confidence UST Services, Inc. Designated Operator's Phone #: 800- 339 -9930 International Code Council Certification #: 8018524 -UC Expiration Date: July 12, 2013 ALTERNATE 2 (Optional) Designated Operator's Name: Sade C. Haake Relation to UST Facility (Check One) Owner Operator Employee Service Technician x Third -Party Business Name (Ifdifferentfrom above): Confidence UST Services, inc. Designated Operator's Phone #: 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, d understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. / NAME OF TANK OWNER (Please Print) , %' 1 V " aj# SIGNATURE OF TANK OWNER: DATE: //— – I OWNER'S PHONE #: (661) 328 -0732 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY THE LOCAL AGENCY LIST IS AVAILABLE AT: www. waterboards .ca.gov /ust/contacts /cupaa agys.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Flower Street Mini Mart Facility ID #: Facility Address: 928 Flower Street Bakersfield, CA 93305 Reason for Submitting this Form (Check One) x Change of Designated Operator Update Certificate Expiration DateFacilityPhone #: (661) 328 -0732 Designated UST Operator(s) for this Facility 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 (Ifdifferentfrom above): Confidence UST Services, Inc. Designated Operator's Phone #: 800 - 339 -9930 International Code Council Certification #: 5258845 -UC Expiration Date: February 17, 2012 ALTERNATE 4 (Optional) Designated Operator's Name: Bryan A Self Relation to UST Facility (Check One) Owner Operator Employee Service Technician X Third -Party Business Name (fdifferent from above): Confidence UST Services, inc. Designated Operator's Phone #: 800- 339 -9930 International Code Council Certification #: 8022804 -UC Expiration Date: November 19, 2012 ALTERNATE 5 (Optional) Designated Operator's Name: Kristopher M. Karns Relation to UST Facility (Check One) Owner Operator Employee Service Technician x Third -Party Business Name (Ifdifferent from above):. Confidence USTServices, 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 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, 9 understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please Print): C in SIGNATURE OF TANK OWNER: C.h DATE: 1 I OWNER'S PHONE #: (661) 328 -0732 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY THE LOCAL AGENCY LIST IS AVAILABLE AT: www. waterboards .ca.l;ov /ust/contacts /cupa agys.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Flower Street Mini Mart Facility ID #: Facility Address: 928 Flower Street Bakersfield, CA 93305 Reason for Submitting this Form (Check One) x Change of Designated Operator Update Certificate Expiration DateFacilityPhone #: (661) 328 -0732 Designated UST Operator(s) for this Facility ALTERNATE 6 (Optional) Designated Operator's Name: Douglas M. Young Relation to UST Facility (Check One) Owner Operator Employee Service Technician X Third -Party Business Name (fdifferentfrom above): Confidence USTServices, Inc. 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 (Ifdifferentfrom above): Designated Operator's Phone #: International Code Council Certification #: Expiration Date: ALTERNATE 8 (Optional) Designated Operator's Name: Relation to UST Facility (Check One) Owner Operator Employee Service Technician Third -Party Business Name (Ifdifferentfrom 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 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 Print): _M SIGNATURE OF TANK OWNER: — y'7 DATE: ( I OWNER'S PHONE #: (661) 328 -0732 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ca.gov /ust /contacts /cupaa agys.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 OUST, ID F4t7CES of COMPLIANCE WITH CONFIDENCE" November 22, 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 Flower Street Mini Mart. Please feel free to contact me should you have any questions. Thank you. Enclosure CONFIDENCE UST SERVICES, INC. t L/uI sintCheriYoung, ic 16250 Meacham Road -Bakersfield, CA 93314 661) 631 -3870 or (800) 339 -9930 FAX (661) 587 -9758