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California Enrimnalantai Repory"r.g System.Business <br /> itome ywon6_3 is FbtWtks 0grwiiyrr:2r Aly <br /> UST Certification of Firierlciei Re,ponsibiiiity:WEST LANE <br /> - <br /> r. iiilikc13�e?I iY U5TUST Cara{V..tion of�.._L..._;Rs_,.c;sic.;r�,.hccep� <br /> ec; <br /> v aTSii>ri,lGutx'45ai�6qt <br /> UST Certifleation of Financial Responsibility Doc umeritabon <br /> Provide a a copy of your UST Certification of Financial Responsibility Documentation as required by your local regulator.Loam more about UST financial responsibility on the State <br /> Water Resources Control Board(SWRCB);i)ahjj.+esau-��ai,.ty s.•.;,and chock with your local regulatorfor information on the format and information requirements needed.and <br /> check with your local regulator for Information on the format ant!Information requirements needed A single form may be provided for multiple ranks at a single facility.A sample <br /> form from the SWRCB is available rw+g. <br /> Select the Edit button to modify/add documentation. <br /> r-Submittal Element History <br /> Submitted for CERS ID WIC,St on 10/172016 6:56PM by RAVINDER SING of RAV,'h9D R 5:lv i fv+T nn.OP,CA) <br /> Submittal was Acceptedon 10119,2016 by NG.WlLLYfor San Joaquin County Environmental Health <br /> Yarn E"*FeaLrmAtw U&I gliew sk > <br /> Document Options Document Upload(s) QF-RS Document Unload Pow <br /> Upload Documents) Date <br /> Document Tine <br /> armored <br /> lis'Certification pf F mania,Resoors,e:,,ty (Adobe PDF 447 KB) 3/2912016 <br /> ... .:yi.tea.,• <br /> lw'.•• : ,. -EX@I.1•t., nAaMd eY RANN.?ER c.tlGH en 10r17=16 5.39 PV <br /> r' tart updated By:RAVINDER SMGH on Ioil 7,2016 6.39 PM <br /> e sti4-,' o:!"Ju�.[.F.3.%'�,u G !?S?> i s�3;:,.t�iryLw ✓w9�.,�• _s�. - '. <br /> Cai:forrNa FnY;fraarental Reriomirq SYS2e" '.i'"`.)rroe ^:r,'C;nmP.�i?.3 arr)tet:hOn AM:nry <br /> CERS Teanicai S K Reouest 7ei;JV t Assistance <br /> ()ruhEv!"ramlGeria.ml asa,ttarrfr!inn#art vr,l;r lor.10 ferlllatorfs) <br /> RECEIVED <br /> OCT 282016 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />