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HomeMy WebLinkAboutSYSTUM OPERATOR 3/18/2011 11111111111111111111 23 IE 70 VERIFY AUTHENTICITY OFLTHIS DOCUMENT YOU MUST TURN OVER AND RUB THE PEARSON VUE LOGO WITH FINGER,AUTHENTIC DOCUMENT WILL CHANGE COLOR FROM ORANGE TO YELLDIV,I F, ^^...,a'.u1ia"".r�g�:aa` `f. � '`.' s•��•: .H M1u wa',:,.7.�ti'��.-�' 1� yy 7s I RIM Ca(ifQrnia UST`'Sysfem Operato. ,: `= AL T _ it�.,.�.:>�'... '.:t`^rt' R'�-hill. �•�.�a r S a�&i �,a Fr. �• � .s!''.•;:k•:`:.,'�""' �,�w��„- .. y, 111RRR 3. Fes':• . �,yV`'J' Candidate ID: XX4&4,f06;G290? f M CHUKI+VUIrMEKA'ODUI ZE Datb. 3118/2011 Tx ,y - . •;se:% U Ad�lte s 25971;. OWNE CENTEt�<DR A x4Bi h Data 10/23/1987 F � Fa ' 3':x'.::3 .>•:.: :: «: " ^. , �� ����93 ::�r,� +:-�`!y'1:TnF_"•�`•�M,�...sr•:��.��f� ..r � yew. r, } • F0011 CA 92610 �;,.. �� ° i fir" < EXAMINATION RESULT``PASS ongratulationsl You have passed the above named examination., Your wallet card wig be forwarderd 0 , f, you by ICC within six wee_s<frofrathe las ' at•;of the month In which you tes#ed. This certificate is c�rrei�fsw for two years. , ..,. .... v itm equest a wall certifcate.from l as well. Throughout 2011•; as ce rate will be provided.atjim-7 p no TER if you request lE`rtiifhin 90"da of our exam. Onl`,ti a wall certifcdte per exam aAl' w t... Ym: y ykx " r,.s •._..s° es`, p p a,a x et �,�WiJt ,li2v�ded to you at hcharge For more information on regtiesfiirg=a wall:C`ertificate,.go to www.�cc$ e.org/inspector. ��°�° f-?�..:" :>�u �' -,�-, •�`. °~-�'�-.�w'`'� '' y`.,•,. •(fir,^ T i+ v* 3 .. .. ...t.r.M:'`4.d-+'��.,.s+.,1r;p�.� 'f.{, G "•'s•w: �• � s.extrsmely important fh t you"riafify"Rearson VUE and)CC of apy;.cli'�g---j name andlor address to avoid`fb��possibifity of you,�:waifet:card:p nciior certificate not beir)greceived.;PleaseLcontact Pearspn,�`' -„•��; ,,;��. �y VUE a:804-275-8301 antt`ICG'at cert�xam cLDlccsafe.org with eFarjgesyourart�e and address(name �j s�may require additional documentation).There may be an additioRa146e`if'a certification is 4 Ns, 5a ils Ued due to a misspelled name or incorrect address. �I ' � . ' 'hd �,:.Y`-'v,.: s.:\s:._.'.:.::;::'.'a.:n-#-^+: •�!h.�1Reti'r:�7°J: t�°�v:b'ia'.LS -t 111M L Y✓�w v�`M.`k-.. s�-�.•,s ..ry•.a�- :�."w°azlyrt;rw''n�°:..�•r".,. "?�r,='. .``VV,�,}•�;.�•.y': +�j9-� r.:. �.fL2� yP sir,�E� ��_ _. i •r.�Fn lk- -a roc. ,•-ry.,,�,`�..�.� �� i �I �>~ �. Yk�. =is;'r. '-'.0:�.+':�>. ��`.;'-»`��Z,,, �,,,F�• .�'"�`i::�'d�� A I S�'"KR" "�.�„��-”t ......"_.x_?.a_ -�;'.a_.�.t`::+..1'.:ri•�.."'ax:y.: .F� F��'3.�v�Y��u�!. �r�_. : 11111111111111111111 0 = f= IE ��� _ 7te.%=iz?�.rs�»°�='�ei;>ra- :i:<.:.�^„t�....a_.;<_<.�cr;;;,1+ .w'::a•"d..:l:s” �s.. 1HOW GNV 133TRIOS SV3k3V U3NUV6 H11M 2HD1'1 O.L NUVC LVOUd Alta/3 ONV A7IVnOV8e HO100 93ONV40 VH1 ONnOUJXOVe O3UO100 Lpm V s"ifavirt00o sou 30 3OVzi 3H1 beishAre environmental services, inc, 25971 Towne Centre Drive,Foothill Ranch,CA 92610 Tel:(949)460-5200 Fax:(949)460-5210 Tuesday, March 22, 2011 p1 iu• California Certified Unified Programs Agency-CUPA Program Kern County Env. Health Svcs Dept. 2700 M Street Bakersfield, CA 93301 SUBJECT: DESIGNATED UST OPERATOR PROGRAM Dear Sir/Madam: Belshire is providing DO services for 7-Eleven. Belshire will be performing monthly UST inspections at the sites listed in Table A. Belshire Designated Operators and ]CC numbers are listed in Table B. Should you have any questions regarding the program, please contact Glen VanderVeen with Belshire Environmental Services, Inc. at(949) 460-5200. Sincerely, Glen VanderVeen Project Manager Belshire Environmental Services, Inc. Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance.with UST Requirements Facility Name: See Table A Facility ID#:See Table A Facility Address: See Table A Reason for Submitting this Form(Check One) See Table A ® Change of Designated Operator Facility Phone#: ❑ Update Certificate Expiration Date Designated UST Operator(s) for this Facility PRIMARY Designated Operator's Name: See Table B Relation to UST Facility(Check One) Business Name(if different from above):See Table B ❑ Owner ❑ Operator ❑ Employee , Designated Operator's Phone#: See Table B ❑ Service Technician ® Third-Party International Code Council Certification#: 8014658-UC Expiration Date: See Table B ALTERNATE 1 O tiona Designated Operators Name: See Table B Relation to UST Facility(Check One) Business Name(ff different from above):See Table B ❑ Owner ❑ Operator ❑ Employee Designated Operator's Phone#:See Table B ❑ Service Technician ® Third-Party International Code Council Certification#:See Table B Expiration Date:See Table B ALTERNATE 2 (Optional) Designated Operator's Name:See Table B Relation to UST Facility(Check One) Business Name(ff different from above):See Table B ❑ Owner ❑ Operator E] Employee Designated Operators Phone#:See Table B ❑ Service Technician ® Third-Party International Code Council Certification#:See Table B Expiration Date:See Table B 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): Stephen Boyd SIGNATURE OF TANK OWNER: DATE: 3/15/2011 OWNER'S PHONE#: 714-674-4292 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/usVcontacts/cupa agys,html. 2)NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. November 2004 TABLE A FaciltjNaine �Faci�lty l4© actyiress 'E' � Ci + �S ate� ip0ode 17-11 116329 1701 PACHEC_ -OW RD_ Bakersfield CA ';93304 C,Q-4�1y 7-11 117721 =3601 STOCKDALE Y :Bakersfield CA '93309 . 17-11 X18655 ;300 NORTH CHESTER AVE €Bakersfield ICA 193308 Cg-.-3qc ;7-11 22647 .12916 ROSEDALE HWY ,Bakersfield CA 93312 i CrQ--�tlb _ .- __.___. __._ ....__ ._ -_.._. ..._ !7-11 E26599 652_9 EAST_B_RUNDA_GE LN }Bakersfield iCA '93307 ' G2-l4 t 7-11 26701 1540 BEAR MOUNTAIN -BLVD Arvin ,CA i93203 1G2-`-403 :5 '7-11 426819 13124 N CHESTER 10ildale CA 93308 CL-yob 17-11 27122 ;1124 6TH ST `Taft CA 93268 C 7-11 132241 14101 Calloway Dr.� -_ _ . Bakersfield CA 93312 M' 17-11 !32257 X5203 Olive Dr. Bakersfield CA ;93308 -1 �s�to �7-11 132376 19600 Brimhall Rd.. Bakersfield CA 193312 i TABLE B beishire environmental services, inc. 25971 Towne Centre Drive Foothill Ranch,CA 92610 Office:(949)460-5200 Fax:(949)460-5210 v"Av.belshire.com Designated Operator List E '#''ia '= QU t +xL 6{• dam. T35Di � 9d Narne �j -:, y fCCert�N,umber,, Ex„Eratlor�. PMorae. ° �� ,. ` !Douglas Shearer 15240897-UC 07/14/12 1(949)460-5200 _............. - Jackie Dougherty X5234433-UC :07/14/12 (94_9)460-5200 Oliver Cruz ;5244318 UC 09/08/12 1(949)460-5200 ;Brian Hernandez 15308636-UC 02/15/12 E(949)460-5200 4Greg Vierra I 53173_32-UC� _107/22/11 1(949) 460-5200 ;Jesse Diaz 18035355-UC 09/04/11 (949)460-5200 iKevin Horn UC X01/22/12 (949) 460-5200 Anthony Greco E8008443 UC 1 0 311 711 2 (949) 460-5200 Cristina Pena ?8010939-UC X05/15/12 1(949)460-5200 Noah Hennin ;8013041-UC 05/26/12 949 460-5200 ,_ ___.._ 9 ) Spencer Platler_ X8014664-UC _ 06/16/12 (949) 460-5_200 1 (Glenda Esteban 18018547-UC :09/08112 1(949)460-5200 jAndy DeGregorio 18019630-UC 10/04/12 1(949) 460-5200 Co iN cholson 8020120-UC 10/08/12 949 460-5200 'Justin Downs__ 18021990-UC :12/07/12 ;(949)460-5200 i _�.._----.._ f Cheron Flores ¢8019649-UC ;10/08/12 :(949) 460-5200 E Grasiela Gama i8022001-UC 12/14/12 1(949)4_60_-_5200 Angelo Georgetti ^8027546-UC� 04/06/11-,--)..(949) 460-5200 Jhustin Abeleda ?8036229-UC 09/26/11 ;(949)460-.5200 F 1 Roman Shekhter 8035361-UC �09/09/11 (949)460-5200 !Adam Burton '8049062-UC 1,12/08/11 '(949) 460-5200 Santi Luangpraseut 18057544-UC 102/11/12 _x(949) 460-5200J Jack N_ estler 80_79218-UC 08/31/12 -(949) 460 5200 I -- ......___ iRicky Diaz _ ;8102023-UC .02/15113 ;(949)460-5200 Emy Odunze [Pending '03/18/13 1(949)460-5200 I