The URL can be used to link to this page

Home My WebLink AboutUSTsCONFIDENCE UST SERVICES, INC. "Compliance With Confidence" August 15, 2007 Mr. Steve Underwood CITY OF BAKERSFIELD Office of Environmental Services Fire Department/UST Program 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 Dear Mr. Underwood: Enclosed please find completed Owner Statements of Designated UST Operator and Understanding of and Compliance with UST Requirements re Addition of Designated Operator Alternate 3 (Jessica L. Meyers) for Jimmy's Market. Thank you for y~,~~;, attention herein. ., Yours truly, - Enclosures ~~:,; •. . CO NCE UST .~`~~ICES , INC . ~~,,; g Cher~r~. I~. rang, Vi -Presi ent Ra.}; 417 Montclair Street • Bakersfield, CA 93309 (661) 631-3870 or (800) 339-9930 FAX (661) 631-3872 Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Jimmy's Market Facility ID #: 015-021-000917 Facility Address: 63l Baker Street, Bakersfield, CA 93305 (City) Reason for Submitting this Form (Check One) X Addition of Designated Operator Facility Phone #: 661-631-1777 ^ Update Certificate Expiration Date Designated UST Operator(s) for this Facility ALTERNATE 3 O tional Designated Operator's Name: Jessica L. Meyers Relafion to UST Facility (Check One) Business Name (If d~erent from above): Confidence UST Services, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 5313857-UC Expiration Date: June 30, 2009 ALTERNATE 4 (Optional) Designated Operator's Name: Relation to UST Facility (Check One) Business Name (If different from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Patty International Code Council Certification #: Expiration Date: ALTERNATE 5 (Optional) Designated Operator's Name: Relation to UST Facility (Check One) Business Name (Ifdifferent from above) • ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party 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) - (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): Girmachew Chekole SIGNATURE OF TANK OWNER: DATE: August 14„ 2007 OWNER'S PHONE #: 661-631-1777 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.Qov/ust/contacts/cupa agYS.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION W[THIN 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: ~ Jimmy's Market Facility ID #: 015-021-000917 Facility Address: 631 Baker Street, Bakersfield, CA 93305 (City) Reason for Submitting this Form (Check One) ^ Change of Designated Operator Facility Phone #: 661-631-1777 X Update Certificate Expiration Date Designated UST Operator(s) for this Facility PRiMARV Designated Operator's Name: Douglas M. Young III Relation to UST Facility (Check One) Business Name (If different from above): Confidence UST Services, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician ~ z -Third-Party ~~ - International Code Council Certification #: 0878646-UC Expiration Date: September 22, 2008 Ai.TF,RNATF. 1 /lh~tinnnl) Designated Operator's'IVame:`=Jennifer Davis ~~'~~~s ~ Relation.t~Ll ili .Gh~6nej;;--~+ Business Name (If different from above): Confidence UST Services, Inc. ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ~ ^ Service Technician x Third-Party International Code Council Certification #: 5252886-UC Expiration Date: March 15, 2009 ALTERNATE 2 (Optional) , D'e"signated Operator's Name:` 'Edward Mitchell : :.. -: ... , .. - •,Relatiomto UST~Facility (Gheck,One),. Business Name (If differentfrom above): Confidence UST Services, Inc. ^ Owner ^ .Operator ^ Employee Designated Operator's Phone #: 800-339-9930 ^ Service Technician x Third-Party International Code Council Certification #: 5258845-UC ~ Expiration Date: May 15, 2008 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). -Further-more, I understand= and-~am~in compliance with :the requirements-(statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please SIGNATURE OF TANK OWNER: DATE: ~' / ~~~ ~ OWNER'S PHONE #: 661-631-1777 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/cu~a ~s.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS t .OF THE CHANGE. November 2004 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD t LINE TESTING t S6989 SECONDARY CONTAINMENT TESTING (TANK TIGHTNESS TEST AND TO PERFORM FUEL FNIONITORING CERTIFICATION PERMIT NO. r1 ~ - ~ ~ I / /~,~,,~.~ - D FIRE DEPT. BAKERSFIE L B A"E~ fi_A_ 9 P] fi L D `~ FIRL ~ - Preveataon `.~lVl~`ieS riG ~ARlMCf 900 Tnixtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 .2S ENHANCED LEAK DETECTION ,ES UNE TESTING .ES SB•989 SECONDARY CONTAINMENT TESTING 2C TANK TIRHI'NFSS TEST FS Tn PFRFCIRM Fl IFI M(~NITORINQ CFRTIFICATION SITE INFORMATION FACILffY I cur NA~,9E $ PHOPoE R1UI~BER OF CONTA T PERSON C ' - 11 ADDRESS ~ OWNERS NAME .~ °OPERATORS NAIl7 -- - s _- ..~ m _ _ _ ----t - -- --- PERMIT TO OPERATE PoO. - _ _ _____ --~- - --- - NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? g YES es NO TANKIZ VOLUME CONTENTS ~\ -- ti~ TANK TESnNG COMPANY NAME OF TESTING COMPANY ` WACaE 8 PHONE NU~JBER OF CORITACT PERSORI - MAIUNG ADDRESS ~- c ~~ i t ~ ke.r S' d' NAME 8 PHONE NUMBER OF TESTER OR SPECU\L INSPECTO Y C~.t~~ o-$ 2 CERTIFICATION #: 3 DATE & nM TEST TO BE CONDUCTED ~ ,m. ICC #: ~ d - TEST METHOD SI NA RE F;A CA ~~ DATE ~ 5 Q _ M EA ® G0 ESA .E ©Y D APPROVED BY / -- .~ - -_--,_.._DATE__~d- ~ - - - - - -- ~ - ---- -- FD 2095 (Rev. 09/05)