HomeMy WebLinkAbout3701 MING AVENUE (4)r 1
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Owner Statements of Designated Underground Storage Tank (UST) Operator
and Understanding of and Compliance with UST Requirements
Facility Name: Fastrip #32 Facility ID #: 3025
Facility Address: 3701 Ming Avenue, Bakersfield, CA 93309
City)
Reason for Submitting this Form (Check One)
x Change of Designated Operator
Update Certificate Expiration DateFacilityPhone #: 661- 397 -3699
Designated UST Operator(s) for this Facility
PRIMARY
Designated Operator's Name: Eric Santos Relation to UST Facility (Check One)
Owner Operator Employee
Service Technician O Third -Party
Business Name (Ifdifferentfrom above): Confidence USTServices, Inc.
Designated Operator's Phone #: 800- 339 -9930
International Code Council Certification #: 8135508 -UC Expiration Date: December 7, 2013
ALTERNATE 1 (Optional)
Designated Operator's Name: Frank J. Landa 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 #: 8018524 -UC Expiration Date: July 12, 2013
ALTERNATE 2 (Optional)
Designated Operator's Name: Catherine Riccomini Relation to UST Facility (Check One)
Owner Operator Employee
Service Technician x Third -Party
Business Name (fdinerenl from above): Confidence UST Services, Inc.
Designated Operator's Phone #: 800- 339 -9930
International Code Council Certification M. 8018933 -UC Expiration Date: September 8, 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) - (fl.
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):
SIGNATURE OF TANK OWNER:
DATE: 1A /,? a // > OWNER'S PHONE #: 661 - 393 -7000
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.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-
It 1
795
Owner Statements of Designated Underground Storage Tank (UST) Operator
and Understanding of and Compliance with UST Requirements
Facility Name: Fastrip #32 Facility ID #: 3025
Facility Address: 3701 Ming Avenue, Bakersfield, CA 93309
City)
Reason for Submitting this Form (Check One)
x Change of Designated Operator
Update Certificate Expiration DateFacilityPhone #: 661- 397 -3699
Desip,nated UST Operator(s) for this Facility
ALTERNATE 3 (Optional)
Designated Operator's Name: Bryan Self Relation to UST Facility (Check One)
Owner Operator Employee
Service Technician x Third -Party
Business Name (/fdifferentfrom above): Confidence USTServicav, Inc.
Designated Operator's Phone #: 800 - 339 -9930
International Code Council Certification #: 8022804 -UC Expiration Date: November 19, 2012
ALTERNATE 4 (Optional)
Designated Operator's Name: Kristopher Karns Relation to UST Facility (Check One)
Owner Operator Employee
Service Technician x Third -Party
Business Name (Ifdifferentfrom above): Confidence USTServices, Inc.
Designated Operator's Phone #: 800 - 339 -9930
International Code Council Certification #: 5264406 -UC Expiration Date: July 19, 2013
ALTERNATE 5 (Optional)
Designated Operator's Name: Douglas M. Young 111 Relation to UST Facility (Check One)
Owner Operator Employee
Service Technician 9 Third -Party
Business Name (Ifdifferentfrom above): Confidence UST Services, Inc.
Designated Operator's Phone #: 800- 339 -9930
International Code Council Certification #: 8043499 -UC Expiration Date: September 12, 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) - (fl.
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): Jamieson Hill Co.
SIGNATURE OF TANK OWNER: Please see page one
DATE: OWNER'S PHONE #: 661 - 393 -7000
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.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
l
D FIDFti
N 0 V•
0 le
COMPLIANCE WITH CONFIDENCE"
January 7, 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 D and G,
Fastrip #621, Fastrip #26, Howard's #4, Farrell's Fastrip,
Fastrip #633, Fastrip #640, Fastrip #6, Fastrip #641, Fastrip
31, Fastrip #19, Howard's, Fastrip #22 and Fastrip #32,.
Please feel free to contact me should you have any
questions. Thank you.
Enclosures
CONFIDENCE UST SERVICES, INC.
6kt,
Cheri Young, ice- resident
16250 Meacham Road • Bakersfield, CA 93314
661) 631 -3870 or (800) 339 -9930
FAX (661) 587 -9758