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Home My WebLink About1131 OAK STREET (5)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# 98109 Facility Address: 1131 OAK ST, BAKERSFIELD, CA, 93304 -1063 Facility Phone# : () 661 - 3247621 PRIMARY Facility ID: 2843 Reason for Submitting this Form (Check One) Change of Designated Operator Update Certificate Expiration Date 0 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 mployee ervice Technician Third -Party Expiration Date : 9/29/2012 Business Name (If different from above) : Designated Operator's Phone # : (925) 842 -9002 International Code Council Certification # : 8041099 -UC ALTERNATE1(Optional) Designated Operator's Name : Chevron Designated Operators Relation to UST Facility (Check One) Elowner [:]operator Dmployee Elervice Technician Third -Party Expiration Date : 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) Owner Operator 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) : DATE: 12/3/2010 Chevron product Company, Attn: Permit Desk OWNER'S PHONE #: (925)842 -9002 Chevron Employee Designated Operator Addendum Chevron Designated Operator Name Phone Number ICC Certificate # ICC Expiration Date Adel Amarin 909 767 -0588 8032306 -UC 10/2112011 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 8/7/2012 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 U 1/30/2012 Michael Wilkinson 707 257 -1224 5296380 -UC 3/31/2012 Chevron Designated Operator Addendum 12- 1- 2010.xis Page 1 Chevron Products Company Marketing HES Permits PO Box 6004, 1-2375 -63 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. 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# 98109 Facility Address : 1131 OAK ST, BAKERSFIELD, CA, 93304 -1063 Facility Phone# : () 661 - 3247621 fliL57c1 1 Facility ID: 2843 Reason for Submitting this Form (Check One) Change of Designated Operator Update Certificate Expiration Date El 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 Employee Service Technician Third -Party Expiration Date : 9/29/2012 Business Name (if different from above) : Designated Operator's Phone # : (925) 842 -9002 International Code Council Certification # : 5250201 -UC ALTERNATE1(Optional) Designated Operator's Name : Chevron Designated Operators Relation to UST Facility (Check One) Owner Operator 0 Employee Service Technician Third -Party Expiration Date: 11/24/2011 Business Name (if different from above) : Chevron Products Compan 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) Owner Operator Employee Service Technician Third -Party Expiration Date : 9/29/2012 Business Name (If different from above) : Designates! 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) : DATE: 12/14/2010 Chevron product Company, Attn: Permit Desk 3 OWNER'S PHONE* (925)842 -9002 OV 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 8/7/2012 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 Calalang 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 r