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IX ELIGIBTLTI'Y REQUIREMENTS (C heck appropriate box for required documentation attacked) <br /> A. THERE MUST HAVE BEEN AN UNAUTHORIZED RELEASE OF PETROLEUM FROM AN UNDERGROUND STORAGE TANK <br /> ® Submit documentation of the lrw6toraad release with that claire appiloation <br /> B. IF CLAIMANT ACQUIRED REAL PROPERTY ON WHICH TANK IS LOCATED AFTER JANUARY 1,1964,CLAIMANT MUST DOCUMENT THAT <br /> REASONABLE DILIGENCE WAS TAKEN TO HAVE DISCOVERED THE TANK AND ANY CONTAMINATION. <br /> �L Submit documentation requested in ina►uc ions. <br /> I C. CLAIMANT MUST BE IN COMPLIANCE WfTH APPLICABLE RC-0UIREMENTS TO HAVE A PEFiAIT TO OWN OR OPERATE THE TANK PURSUANT <br /> i <br /> TO SECTION 23254 OF CHAPTER 6.7 OF THE HEALTH AND SAFETY CODE <br /> 1 C� Submh a copy of perni issued by to local agency,in elect n the time twnand o unauthorized release was diaved areported:OR <br /> 21S_l Submit evidence of having filed an application for the permit by January 1,1990;OR <br /> 3❑ Submit doeunkaftoon dernonaratmg that obtaining to requned permt win beyond the carran's reasonable contol,or reason that it <br /> would be unreasonable or nequ,abl to require"Ming of an application for peruke by January 1.1900. <br /> 4 n Check here if the ank(s)is a'snell hone heating oil taw as dMned in Sectors VIII. PRIORITY CLAW DESIGNATION and therefore m exor,w <br /> from this reourement <br /> 'D. CORRECTIVE ACTION MUST BE W COMPLIANCE WITH APPLICABLE PROVISIONS OF CHAPTER 5.7 OF THE HEALTH AND SAFETY CODE <br /> j THE FEDERAL ACT.LOCALAGENCY ORDERS AND DIRECTIVES.ORDERS AND DIRECTIVES OF THE BOAfO OR REGIONAL BOARD. <br /> u AND THE CORRECTIVE ACTION REGULATIONS IMPLEMENTED IN ARTICLE 11,CHAPTER 16.DIVISION S.TITLE 23A CAUFORNA CODE <br /> OF REGULATIONS <br /> 1® Fa eareci action boar incurred prior to to effective date of the Clawi Fund regulators submit doasrsenmbn tat corrective anon <br /> work vws eoniid rt with requiremki <br /> 2Z] For carei actin toad incurred afar the effective daft of the Cleanup Fund rapWton,subml documentation that corrective anon <br /> work was required a permitted <br /> E. CLAIMANT MUST BE W COMPLIANCE WITH APPLICABLE REQUIREMENTS TO DEMONSTRATE FINANCIAL RESPONS481UTY <br /> 1. IS CLAIMANT SUBJECT TO THE REQUIREMENT TO DEMONSTRATE FINANCIAL RESPONSIBILITY: <br /> ® NO IF-NO.IDENTIFY EXEMPTION OR DEFERRAL(40 CFR PART 260 OF THE FEDERAL REGULATIONS)AND PROCEED TO c <br /> Tanks have been removed and closure is nerformed under the RWOCB <br /> C3 YES IF-YES'.coNTINUETO NEXT QUESTION Local Agency Oversight Program. <br /> 2. IDENTIFY DATE SPECIFIED IN THE FEDERAL ACT BY WHICH CLAIMANT MUST COMPLY WITH DEMONSTRATING FINANCIAL RESPONSIBILITY ANC <br /> IF DATE IS IN THE FUTURE OR DEFERRED.PROCEED TO PAGE 7. <br /> F7 JANUARY 24. 1968 for ata p"roleum markearsg kms awning 1.000 a more u idrgrovd dorage ants and AN 00 - underground storage <br /> tank owrws who report a tanpble ret wash of S20 r"lm a nae b to U.S.Seemdw and Em:#= a Com miam on(SEC),Oun an0 <br /> Bradateet.the Energy Imlcrma t on Admanistaton a to Rural Electrification Admrrtation <br /> Cj OCTOBER 26. 1969 for W patoleun mrkeap Amro owing 100 to ON uhdr¢and storage twin <br /> u APRIL 26, 1901 for of petroleum marketing kms owning 13 tip OO urdrgrard wage ane at nae than ore facility <br /> DECEMBER 31, 1993(Reciammerded EPA Date)for all petroleum underground atrage tank owners or opervi not desaiba0 above <br /> F7 Loral govarnrrrhW ahetiea we not eurerdy,subj,k ro a adral oanplirsee daft <br /> 3. IDENTIFY THE MINIMUM AMOUNT OF FINANCIAL RESPONSIBIUTY REQUIRED AS DEFINED BY THE FEDERAL ACT: <br /> Sl milkah pr o=urrue fa ower"and operator Of udegroud sttlraga tenor*Ww bated at a pstc" r mrkebw faGilM a which <br /> handl"an average of more tan 10.000 gallon of Petroleum pr month breed on erred throughput for the previous calendar year: <br /> OR <br /> 17 $500.000 pear orxurence for W owners and Operators rot included n the above statement <br /> AND <br /> S1 millias arcual agQepafe wtraga}or taartrt sed t1p"nlrs of t to 100 underground slip"frits <br /> OR <br /> $2 million annual aggregate bufverage for Owners cad operation;of 101 or more a id"proud 91droge Nita. <br /> 4. IDENTIFY THE MECHANISM(S)USED TO DEMONSTRATE FINANCIAL RESPONSIBILITY: <br /> bTRUSTFUND 15SURETYBOND 8GUARANrEE 8SELFINSURANCE 15LEREROFCREDTr [5INSURANCECOVEFi <br /> 8 RISK RETENTION GROUP 15 STATE FUND —if using State Fund,irdkste mairirn for providing required 510.000 covrac <br /> NEW 12191) PAGE a <br />