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STATE WATER RESOURCES CONTROL BOARD DIVISION OF CLEAN WATER PROGRAMS UST LOCAL OVERSIGHT PROGRAM STANDARD AGREEMENT NO. 8-014-550-0 NOTICE OF RESPONSIBILITY SITE CODE: DATE FIRST REPORTED: SITE NAME: SUBSTANCE: ADDRESS: FEDERAL (Y) STATE (N) CITY: STATE: CA ZIP: RESPONSIBLE PARTY: RESPONSIBLE PARTY CONTACT: ADDRESS: CITY: STATE: ZIP: Pursuant to Sections 25297.1 and 25297.15 of Chapter 6.7 of the Health and Safety Code, you are hereby notified that the above site has been placed in the Local Oversight Program and the individual(s) or entity(ies) shown above, or on the attached list, has been identified as the party(ies) responsible for investigation and cleanup of the above site. Section 25297.15 further requires the primary or active responsible party to notify all current record owners of fee title before the local agency considers cleanup or site closure proposals or issues a closure letter. This agency is prepared to perform these required notifications, as part of its contract with the SWRCB, provided that the primary or active responsible party certifies that those responsible parties identified above, or on the attached list, includes all current record owners of fee title for the subject property. It is your responsibility to determine which of you is the primary or active RP and to submit a letter, within 20 calendar days of receipt of this notice, either certifying the accuracy and completeness of the information shown above, or on the attached list, or correcting this information to make it accurate and complete. Also, if property ownership changes in the future, you must notify this local agency within 20 calendar days of when you are informed of the change. Any action or inaction by this local agency associated with corrective action, including responsible party identification, is subject to petition to the State Water Resources Control Board. Petitions must be filed within 30 days from the date of the action/inaction. To obtain petition procedures, please FAX your request to the State Water Board at (916) 227-4349 or telephone (916) 227-4408. Pursuant to Section 25299.37(c)(7) of the Health and Safety Code, a responsible party may request the designation of an administering agency when required to conduct corrective action. Please contact this office for further information about the site designation process. Contract Project Director: Date Signature Telephone Number Add: X Reason: ADD NEW SITE Delete: Reason! Change: Reason: (NOR REV 12131198)