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X. STATEMENTS A. IDENTIFY ANY OTHER PERSONS)THAT MAY HAVE FILED A CLAIM AGAINST THE US i ;LEANUP FUND FOR CLEANUP OF THE SITE WHICH IS THE SUBJECT OF THIS CLAIM: Marjorie Conrady, c/o Neumiller and BearAcTPP NAME 509 W. Weber, Stockton, CA 95203 (209) 948-8200 ADDRESS TELEPHONE NO. B. IDENTIFY OTHER PERSON(S)WHO HAVE INCURRED COSTS FOR CLEANUP OF THE SITE VMICH IS THE SUBJECT OF THIS CLAIM None NAME I' ADDRESS TELEPHONE NO. C. DO YOU HAVE ANY KNOWLEDGE OF ANY CONTROVERSY(LAWSUITS,ETC.)REGARDING THE SITE THAT IS THE SUBJECT OF THIS CLAIM? 1I NO 'I YES -PLEASE E%PLAIN: XI. CERTIFICATIONS AND AGREEMENTS I(WE) HEREBY CERTIFY THAT: 1. I(We)rn(are)the owner or opera w of an Underground Storage Tarst from* moi thM has been n u outhor¢ed release of petroleum for which a Gum against the Fund is permissible under Chapter 6.75 of de Califorrka Health and Sooty Code. 2. Cla mantis)a(w)entood to submit this clan application for rewnWraemerR tom the Fund 2, All costs claimed h~wen wend aaer January 1,191111.r reasonable and necessary.erld re eigble t e f9wribtYMrent from the Fund. e. Clalmrt(s)Obtained any perrtute required of the demerits)mritlU under Chapter 6.7 of the CaMtome Mesith and Salety Code when such PermAa wen required or claimarm(s)had filed substantially complete apPkamons for any permas required of clumrit(N on January 1,19K by that data,or M clamant cannot w suety.claimant hu wbmitted docwmenadon of the tecta rte aarmstraes wtkdt N relied upon to demonstrate that obtaalng eery requ od Perms was beyord the reasonable control of dlwnanls)or that a would be unnawnable or inequitable to nquve de alalnemla)to have fled an application for such a oarmn by January 1990. S. CWmrn(s)rat in compliance with airy applicable 11ruraW responsibility requirements;contaaed In Article J,Chapter Is,Division 0,Title 20,California Code of Regulations(Petroleum Underground Storage Twat Clerso Fund Regulations). 6. As to W coats cWned wdkdh were Incurred Debre 6ne Mfoativs data of Cleanup Fund reguiabom(Deerrlbr 2,1991),wry corrective action taken by claimamlq was: A. In accordance with oppkabM provisions MChapter 6.7 ofthe California Heath and Safety Code and Subchapow IX of Chapter 82 of Tide 42 of ill Urated Stat"Code and the Federal Rogulatfore adopted pursuant therow;and S. Consistent with rry oral or written orderL dreWws,approvals or rlotlseation of dMen o neponsibdity,issued by"a.local or federal agencies having autilort y or responsibility over underground storage tanks,end consiatwt witn any appuc—ia wase discharge ngrerlraa.stab pokdes for wow galay control,cow watr quality control plea. 7. As to ane costs cumad whidh were incurred n or aaw 1M ellectve dere of Cleanup Fund Regulative(December 2,1991): A. Claimrtis),If subject to the Pemat requirements of Chapter 6.7 of the California,Health and Sally Code.(1)we n compliance with efts)applicable corrsceve action ngWenenb•stabasMd pursuant to Article a of Chapter 8.75 of the California Hearth and Sally Code,including any impemnng regulations contained in Anis 11,Chapter 16,Diviswn 0, Title 20,California Code of RegWatfons:and(2)has(have)notified the spproonsto Ideal agency or Cuilomla Regional Water Quality Comol Board of the meas•l.+lid is the subject of this tarn and has(have)been required or permitted by such agency or agencea to undrtalre the corrective action for wmich nenbvsrfent is sought.and dumarw a) is Carel in comptwae wan the naremrts or any order or orecivea iaswtl DY such aperalea. I 8, Clumam(s),0 not subject W Ne Parra requremwrts of Chapter 11.7 of the Cakfonka Healtll and Safety Code.meet the conditions specified an Paragraph 6 above. 8. Claimam(s)old not know of the unwrhon"d relesaa Watch is the subject of this Wim pier to January 1,Ili Or.it Such renew wea known onor to that site. any rodwed corrective action related to that release was imbatatl on or before June 30.1966 9. Claimwmis).if owners)of tie vie involved dove(do)not know of any facts which would Preclude rry party from Worm me sae wee acquired from fling a cisim for ntfigling the Ftind �, LPI PAGE 7