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State Water Resources Control Board <br /> Underground Storage Tank Cleanup Fund <br /> PERMIT WAIVER REQUEST FORM <br /> CLAIM NO.: 13850 <br /> CLAIMANT NAME: . GET-N-GO MART <br /> SITE ADDRESS: 574 GRANTLINE RD,TRACY <br /> Claimants who were subject to the permit requirement but failed to comply by January 1, 1990,can request the State Water Resources <br /> Control Board{SWRCB)to waive the requirement as a condition for eligibility if the four requirements listed below have been met. <br /> Where the SWRCB grants the waiver, the'level of required deductible the above- <br /> is twice the amount otherwise required. In this case, <br /> named claimant will be responsible for the first S10,000 of eligible corrective action costs before Fund coverage begins.. <br /> "I,GET=N-GO,MART,'HEREBY REQUEST.•THE SWRCB TJ GRAI�TTA PERMIT:VSIAIVER.�TO.QUALIFY FOR <br /> WAIVER,i AM SUBMITTING DOCUMENTATION SHOWING THAT THE FOLLOWING FOUR PERMIT WAIVER <br /> REQUIREMENTS HAVE BEEN MET:, <br /> 1. The claimant was unawaie of the permit requirement prioi to January 1, 1990,and did not intend to avoid the permit <br /> requirement or the associated fees. <br /> DOCUMENTATION- Provide a brief history of�the UST(s)and an explanation as to why the UST(s)were not <br /> permitted by January 1, 1990. Explain when and how you became aware of the law requiring a permit to own.or. <br /> operate the UST(s)."(Attach additional sheets as necessary.) <br /> I <br /> 2. Prior to filing a claim,the claimant has complied with the financial.responsibility requirements of Section 25299.31 of the <br /> Health&Safety Code(H&SC). <br /> DOCUMENTATION: Attach a copy of the Certificate.of Financial Responsibility that is on file with the local <br /> regulatory agency.. <br /> 1 The claimant has obtained and paid for all currently required permits. <br /> DOCUMENTATION: If you owned or operated the UST(s)at the time of submitting the claim application, attach <br /> a copy of the permit to own or operate the UST(s)or a copy of the application to the local agency for a permit <br /> indicating that youaf` diligently pursuing the acquisitionof•a permit,-If the°L•TST!(s)-were removed prior-to:. <br /> r submitting your claim application, attach evidence that the UST(s)were removed, and the local regulatory agency <br /> notified, and a copy of the removal'permit. <br /> 4. The claimant has paid all current USTxfees imposed by Section 25299.41"of the H&SC, and all prior fees due on and after- <br /> January 1, 1991. . <br /> DOCUMENTATION: If any of the USTs owned or operated had product placed.in them on or after January 1, <br /> 1991, attach the most recent copy of the UST Fee Return Form filed with the State-Board of Equalization with <br /> proof of payment. <br /> CLAIMANT SIGNATURE: <br /> PRINT SIGNATURE . DATE: <br /> Note: Mail completed "Permit Waiver Request"and documentation to the address on the cover letter. <br /> California EnvironTental Proteetion Agency <br /> �' RRecvcled Paper <br />