HomeMy WebLinkAbout2222 F STREET (4)Owner Statements of Designated Underground Storage Tank (UST) Operator
and Understanding of and Compliance with UST Requirements
Facility Name: Ramco Express Facility ID #:
Facility Address: 2222 F Street
Bakersfield, CA 93301
Reason for Submitting this Form (Check One)
x Change of Designated Operator
Update Certificate Expiration DateFacilityPhone #: --3z—,w / 7- 8
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 (Ifdifferent from 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 (Ifdifferent from above): Confidence USTServices, 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 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 OWNI
SIGNATURE OF TANK
DATE: j OWNER'S PHONE #: gl B 3/ 7 -7- 9 g
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 /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: Ramco Express Facility ID #:
Facility Address: 2222 F Street
Bakersfield, CA 93301
Reason for Submitting this Form (Check One)
x Change of Designated Operator
Update Certificate Expiration DateFacilityPhone #: /:11 175A,
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 (Ifdifferent from above): Confidence USTServices, 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 (!fdifferentfrom 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 (f differentfrom above):. Confidence UST Services, 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, 1 understand and am in compliance with the requirements (statutes,
regulations, and local ordinances) applicable to underground storage tanks.
NAME OF TANK OWNI
SIGNATURE OF TANK
DATE: 9, / / OWNER'S PHONE #• gl 3,9 72—Bg
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 /cupaa agys.html.
2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS
OF THE CHANGE.
November 2004
1
Owner Statements of Designated Underground Storage Tank (UST) Operator
and Understanding of and Compliance with UST Requirements
Facility Name: Ramco Express Facility ID #:
Facility Address: 2222 F Street
Bakersfield, CA 93301
Reason for Submitting this Form (Check One)
x Change of Designated Operator
Update Certificate Expiration DateFacilityPhone #: %
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 (/fdifferent from 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 (/fdifferent from 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 (/fdifferentfrom above):.
Designated Operator's Phone #:
International Code Council Certification #: Expiration Date:
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, f understand and am in compliance with the requirements (statutes,
regulations, and local ordinances) applicable to underground storage tj%nlcs.
NAME OF TANK OWNER (PL
SIGNATURE OF TANK OWN
DATE: l // OWNER'S PHONE #: 91S _33>52- ` Z
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 /cupa agys.html.
2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS
OF THE CHANGE.
November 2004
Ce
NcEs o
COMPLIANCE WITH CONFIDENCE"
February 14, 2012
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 5 Star Gas
Shell, Jungle Color Int'1. dba Texaco Minit Stop, Ramco Express
and Sparkling Image Car Wash.
Please feel free to contact me should you have any
questions. Thank you.
Enclosures
CONFIDENCE UST SERVICES, INC.
0",
Cheri Young ice -P sident
16250 Meacham Road ° Bakersfield, CA 93314
661) 631 -3870 or (800) 339 -9930
FAX (661) 587 -9758