HomeMy WebLinkAbout4101 CALLOWAY DRIVE (2)Owner Statements of Designated Underground Storage Tank (UST) Operator
and Understanding of and Compliance with UST Requirements
Facility Name: 7 -11 32241 Facility ID #: 32241
Facility Address: 4101 Calloway Dr.
Bakersfield, CA 93312
Reason for Submitting this Form (Check One)
Change of Designated Operator
Update Certificate Expiration DateFacilityPhone #: (661)587 -8826
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 (If different from above): Belshire Environmental Services, Inc.
Designated Operator's Phone #: (949) 460 -5200
International 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 (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
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: —Aoll
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 /cur)a agys.html.
2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS 9RMATION- WITHIN 30 DAYS OF THE
CHANGE.
MAY 1 , 2011 November 2004
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environmental services, inc.
25971 Towne Centre Drive, Foothill Ranch, CA 92610
Designated Operator Alternate List
Na a CC Ce W atIM P,ho'ne
Jhustin Abeleda 8036229 -UC 9/26/20.11 949) 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 9/82012 949) 460 -5200
Cheron Flores 8019649 -UC 10/8/2012 949) 460 -5200
Grasiela Gama 8022001 -UC 12/142012 949) 460 -5200
Angelo Georgetti 8027546 -UC 3222013 949) 460 -5200
Anthony Greco 8008443 -UC 3/17/2012 949) 460 -5200
Noah Henning 8013041 -UC 526/2012 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 9/92011 949) 460 -5200
Greg Vierra 5317332 -UC 722/2011 949) 460 -5200