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HomeMy WebLinkAbout3015 WILSON ROAD (5)i Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Plaza Towers Facility ID #: Facility Address: 3015 Wilson Road Bakersfield, CA Reason for Submitting this Form (Check One) O Change ol'Designated Operator Update Certificate Expiration DateFacilityPhone #: 661- 631 -8500 Designated UST Oyerator(s) for this Facility PRIMARY Designated Operator's Name: Frank Landa Relation to UST Facility (Check One) Owner Operator Employee Service Technician 17 Third -Party Business Name (Ifdifferentfrom above): Confidence UST Services, Inc. Designated Operator's Phone #: 800- 339 -9930 International Code Council Certification #: 8018524 -[JC Expiration Date: July 12, 2013 ALTERNATE l 0 )tional Designated Operator's Name: Catherine Riccomini Relation to UST Facility (Check One) Owner Operator Employee Service Technician O Third -Party Business Name (Ifdifferentfi-oin above): Confidence UST Services, Inc. Designated Operator's Phone #: 800 -339 -9930 International Code Council Certification #: 8018933 -UC Expiration Dale: September 8, 2012 ALTERNA'T'E 2 (Optional) Designated Operator's Name: Edward Mitchell Relation to UST Facility (Check One) Owner Operator Employee Service Technician 21 Third -Party Business Name (Ifdifferentfrom above): Confidence UST Services, Inc. Designated Operator's Phonc #: 800- 339 -9930 International Code Council Certification #: 5258845 -UC Expiration Date: February 17, 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 OWNER (Please Print): Housing Authority of the County 0 Kern SIGNATURE OF TANK OWNER: J DATE: ! OWNER'S PHONE #: 661- 631 -8500 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 TH_E CHANGE. November 2004 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Plaza Towers Facility ID #: Facility Address: 3015 Wilson Road Bakersfield, CA Reason for Submitting this Form (Check One) O Change of Designated Operator Update Ceti ificate E=xpiration DateFacilityPhone #: 661 - 631 -8500 Designated UST Operator(s) for this Facility PRIMARY Designated Operator's Name: Bryan Self Relation to UST Facility (Check One) Owner Operator Employee Service Technician 0 Third -Party Business Name (Ifdifferenifrom above): Confidence USTServices, Inc. Designated Operator's Phone #: 800- 339 -9930 International Code Council Certification #: 8022804 -UC Expiration Date: November 19, 2012 ALTERNATE I (Optional) Designated Operator's Name: Krislopher Kams Relation to UST Facility (Check One) Owner Operator t:mploycc Service Technician © Third -Party Business Name (Ifdifferentfi•rnn above): Confidence UST Services, Inc. Designated Operator's Phone #: 800 - 339 -9930 International Code Council Certification #: 5264406 -UC Expiration Date: July 18, 2013 ALTERNATE 2 (Optional) Designated Operator's Namc: Relation to UST Facility (Check One) Owner Operator Employee Service Technician Third- Party Business Name (Ifdifferentfront above): Confidence UST Services, Inc. Designated Operator's Phone #: 800 - 339 -9930 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) - (t). 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): Housing Authority of the County of Kern SIGNATURE OF TANK OWNER: DATE: I6 OWNER'S PHONE #: 661- 631 -8500 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.yov /ust /contacts /cupa ag syhtml. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 OAF I DItti N . 4 0 ICES , COMPLIANCE WITH CONFIDENCE" October 11, 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 for Plaza Towers. Thank you for your attention herein. Enclosure Yours truly, CONFIDENCE UST SERVICES, INC. C. Karli Karns, Dispatch Coordinator 16250 Meacham Road -Bakersfield, CA 93314 661) 631 -3870 or (800) 339 -9930 FAX (661) 587 -9758