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Home My WebLink About900 MONTEREY ROADOCT -13 -2011 10:27 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements P.13 Facility Name: Arco AM PM Facility m #: Facility Address: 900 Monty Road Bakersfield. CA 93305 Reason for Submitting this Form (Check One) 10 Change of Designated Operator Update Certificate Expiration DateFacilityphone #: 661 -835 -8044 Desionted UST Operator(s) for this Facility PRIMARY Designated Operator's Name: Catherine C. Riccomini Relation to UST Facility (Check One) Owner O Opa-sAw Employee Service Technician X Third -Parry Business Name (ifdiffermifrom above).- CaOdence USTServices, Inc. Designated Operator's Phone a: NO-339 -9930 International Code Council Certification #: 8018933 -UC Expiration Date: September 8, 2012 ALTERNATE 1 (Ontio" Designated Operator's Name: Frank Landa Relation to UST Facility (Check One) Owner Operator Employee O Service Technician x Third -Party Business Name (Ifd($erentfrom above.): CogUence USTSerrices, 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. Haakc Relation to UST Facility (Check One) Owner Operator Employee Service Technician x Third -Party Business Name (ifdifferentfrom above): Cotdidence USTSert4cas, Inc. Designated Operator's phone #: 800 - 339.930 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 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 to . NAME OF TANK OWNER (Please P'rinnt': SIGNATURE OF TANK OWNER: V J DATE: =A-It OWNER'S PHONE #-bbQ OF 010111W 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, vmterboards .oa.sov /usdcontacW"pg aevs.htrnt. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANCES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 OCT -13 -2011 10:28 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements F.14 Facility Name: Arco AM PM Facility 1D #: Facility Address: 900 Monterey Road Bakersfield, CA 93305 Reason for Submittiog this Fort (Check One) N Change of Designated Operator Update Certificate Expiration DateFacilityPhone #: 661- 835 -8044 ALTERNATE 3 (Ontionan Designated Operator's Name: Edward Mitcbcll Relation to UST Facility (Check One) Owner Operator Employee Service Technician X Third -Parry Business Name (Ifdi,8erent from above): Confidence USTSendces, Inc. Designated Operator's phone $$: 800- 339 -9930 International Code Council Certification #: 5258845 -UC Expiration Date: February 17,2012_ ALTERNATE 4 (Ootlonal) Desigoated Operator's Name: Bryan A Self Relation to UST Facility (Check One) p Owner Operator O Employee Service Technician x Third -Party Business Name (tfd( erentfromabove).• Confidence UST Services, inc. Designated Operator's Phone #: $00 -339 -9930 International Code Council Certification W. 9022804 -UC Expiration pate: November 19, 2012 ALTERNATE S (OptimmO Designated Operator's Name: KristopberM, Karns Relation toUST Facility (Check One) Owner Operator O Employee Service Technician x Third -Party Business Name (ffdiffePwafrom above) :.Coodence U57Semicei, Inc. DesigrWed Operator's Phone #: M339.9930 Intemational Code Cotmcil 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) - (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 (Please SIGNATURE OF TANK OWNER: DATE: OWNER'S PHONE #: & a `— 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; www. waterlroards .ea.eovlusdcontacta/cuea aevs.htrni. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INPORMATION WnUIN 30 DAYS OF THE CHANGE. November 2004 OCT -13 -2011 10:28 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements P.15 Facility Name: Arco AM PM Facility ID #: Facility Address: 900 Monterey Road Bakersfield. CA 93305 Reason for Submitting this form (Check One) Change of Designated Operator 0 ClpdateCertificate Expitatioo DateFacilityPbonc #: 661. 835.8044 Designated UST O>Qerator(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 Businum Name (ifdi ferentJiom above): CorlQdance U3TSerWcer, 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 Busitess Name Qfd0 rentfront above): Designated Operator's Phone #: International Code Council Ceni cation #; Expiration Date: ALTERNATE 8 (Optlonan Dcsignatcd Operator's Name: Relation to UST Facility (Check One) Owner O Operator Employee Service Technician O Third -Party Business Name (.Ifdi, jferentfrom 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 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 atora a tanks. NAME OF TANK OWNER (Please `Print): SIGNATURE OF TANK OWNER: DATE: = d0 -9 OWNER'S PHONE #: &&/ a0 ow 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 waterboards ca itov /ust /ccmtarts/cuya_a(xya htmt. I) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. Novcmber 2004