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Home My WebLink AboutUST-OWNER 10/25/2010 IIIIIII VIII III IIII 29 UNDERGROUND STORAGE TANK SYSTEM lE OWNER STATEMENTS OF DESIGNATED UST OPERATOR AND UNDERSTANDING OF AND COMPLIANCE WITH UST REQUIREMENTS For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23, Div. 3, Ch. 16 California Code of Regulations(CCR) FACILITY NAME FACILITY PHONE L. Q Tf�_ _ ( «'3 ) �� 3 g l? FACILITY SITE ADDRESS CITY REASON FOR SUBMITTING THIS FORM(Check One): Change of Designated Operator ❑ Update of]CC Certification Expiration Datc(s) PRIMARY DESIGNATED UST OPERATOR FORTH IS FACILITY DESIGNATED OPERATOR NAME: STEVEN OBERT RELATION•TO UST FACILITY((-heck One) 13uSINI SS NAME(Ifd;ifferentjrom above): RICH ENVIRONMENTAL ❑ Owner ❑ Operator ❑ Employcc DESIGNATFD OPERATOR PHONE: (661) 706-8190 ext. ® Service Technician ❑ 'third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: 8029980-UC EXPIRATION DATE: 6/16/2011 ALTERNATE I DESIGNATED UST OPERATOR FOR THIS FACILITY O tional . DESIGNATED OPERATOR NAME: RICHARD MASON RELATION TO US"T FACU TTY(Check One) BUSINESS NAME (lfdiiferentfromabove): RICH ENVIRONMENTAL ❑ Owner ❑ Operator ❑ Employcc DESIGNATED OPERATOR PHONE: (661) 706-8690 ext. ® Service Technician ❑ 'Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: '55297857-UC EXPIRATION DATE: 11/15/2010 ALTERNATE 2 DESIGNATED UST.OPERATOR FOR THIS FACILITY(Optional) DESIGNATFIj OPERATOR NAME: JOANNE McCAIN RELATION TO UST FACILITY(Check One) BUSINESS NAME(ifdi erentfromabove): RICH ENVIRONMENTAL' ❑ Owner ❑ Operator ❑ Employee DES IIGNATi:D OPERATOR PHONE: (661)706-9581 ext. ® Service'rcchnician ❑ 'Third-Parry INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: 5320112-UC EXPIRATION DATE: 11/15/2010 ALTERNATE 3 DESIGNATED UST OPERATOR FOR THIS FACILITY(Optional) . DFSI(;NA'TED OPERATOR NAME: JERRY GONZALEZ RELATION TO UST FACILITY((.'heck One) BUSINESS NAME(OfdQerentfromabove): RICH ENVIRONMENTAL ❑ Owner ❑ Operator ❑ Employcc DESIGNATF.D OPERATOR PI ION E: (661) 326-81552 ® Se.,-rviceTechnician ❑ Third-Party INTERNATIONAL CODE:COUNCIL CERTIFICATION NO.: 8058915-UC EXPIRATION DATE: 2/24/2012 1 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)through (f). Furthermore, 1 understand and am in compliance with the requirements(statutes,regulations,and local ordinances)applicable to underground storage tanks. TANK OWNER NAME: TANK OWNER TITLE: OWNER PHONE: ) g TANK OWNER SIGNATURE:?( _ DATE: -.. .INSTRUCTIONS _ y I._ Report the.nare(s)-of the Designated LOperator( as r egistered with beAntetnational�Code Council (ICC). ICC certification information is available-on-line at: wwe/e a .1tml:Search for"California UST-System Operators.".- _ *2. Submit this completed form to the 'local agency that regulates this facility's USTs. Unidocs member agency jurisdictions and contact information are listed on-line at: www.unidocs.org/members/whoregulateswhatbtmi. Contact information for other local agencies within California is available at:www.swreb.ca.gov/cwph6me/usV contacts/docsAocal_agency_list.xis. 3. 23 CCR§2715(a)requires that you notify the local agency of any changes to this information within 30 days of the date of change. UN-062-1/1 wwvv.unidocs org 09022/05 IIIIIIIIIIIIIIIIIIII 30 IE UNDERGROUND STORAGE TANK SYSTEM OWNER STATEMENTS OF DESIGNATED UST OPERATOR AND UNDERSTANDING OF AND COMPLIANCE WITH UST REQUIREMENTS For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23, Div. 3, Ch. 16 California Code of Regulations(CCR) FACILITY NAME FACILITY PHONE L PETRO, INC (818)667-3178 FACILITY SITE ADDRESS CITY 80034TH STREET BAKERSFIELD REASON FOR SUBMITTING THIS FORM(Check One): Change of Designated Operator E Update of ICC Certification Expiration Date(s) PRIMARY DESIGNATED UST OPERATOR FOR THIS FACILITY DESIGNATED OPERATOR NAME: STEVEN OBERT RELATION TO UST FACILITY(Check One) BUSINESS NAME(If dtfgferentfromabove): RICH ENVIRONMENTAL ❑ Owner ❑ Operator ❑ Employee DESIGNATED OPERATOR PHONE: (661) 706-8190 ext. ® Service Technician ❑ Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: 8029980-U C EXPIRATION DATE: 6/16/2011 ALTERNATE 1 DESIGNATED UST OPERATOR FOR THIS FACILITY donal DESIGNATED OPERATOR NAME: RICHARD MASON RELATION TO UST FACILITY(Check One) BUSINESS NAME(If di erentfromabove): RICH ENVIRONMENTAL ❑ Owner ❑ Operator ❑ Employee DESIGNATED OPERATOR PHONE: (661) 706-8690 ext. ® Service Technician ❑ Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: 55297857-UC EXPIRATION DATE: 11/5/2012 ALTERNATE 2 DESIGNATED UST OPERATOR FOR THIS FACILITY(Optional) DESIGNATED OPERATOR NAME: JAMES RICH RELATION TO UST FACILITY(Check One) BUSINESS NAME(1fdtffererdfromabove): RICH ENVIRONMENTAL ❑ Owner ❑ Operator ❑ Employee DESIGNATED OPERATOR PHONE: (661) 706-8687 ext. ® Service Technician ❑ Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: 1064166-UC EXPIRATION DATE: 11/5/2012 ALTERNATE 3 DESIGNATED UST OPERATOR FOR THIS FACILITY(Optional) DESIGNATED OPERATOR NAME: RYAN MASON RELATION TO UST FACILITY(Check One) BUSINESS NAME(1fdffferentfromabove): RICH ENVIRONMENTAL ❑ Owner ❑ Operator ❑ Employee DESIGNATED OPERATOR PHONE: (661) 706-8689 ext. ® Service Technician ❑ Third-Party INTERNATIONAL CODE COUNCIL CERTIFICATION NO.: 8029371-UC EXPIRATION DATE: 6/9/2011 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)through (f). Furthermore, I understand and am in compliance with the requirements(statutes,regulations,and local ordinances)applicable to underground storage tanks. TANKOWNERNAME: BEN SHIRALIAN TANK OWNER TITLE: OWNER OWNER PHONE: (8 18) 667-3178 TANK OWNER SIGNATURE: DATE: February 25, 2011 INSTRUCTIONS 1. Report the name(s) of the Designated UST Operator(s)as registered with the International Code Council (ICC). ICC certification information is available on-line at:www.icesafe.org/e/certsearch.htmi. Search for"California UST System Operators." 2. Submit this completed form to the local agency that regulates this facility's USTs. Unidocs member agency jurisdictions and contact information are listed on-line at: www.unidoes.org/members/whoregulateswhat.htmi. Contact information for other local agencies within California is available at:www.swrcb.ca.gov/cwphome/ust/contacts/docs/local_agency_list.xls. 3. 23 CCR§2715(a)requires that you notify the local agency of any changes to this information within 30 days of the date of change. UN-062-1/1 www.unidocs.org 09122/05