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• t, <br /> t <br /> i <br /> V. <br /> NOV 1 :IAN- <br /> Mc �, <br /> r <br /> Joau <br /> 101 <br /> Rex <br /> v�wn a6f�e <br /> of- <br /> f <br /> ,C f <br /> i�� on�c 110 <br /> t- <br /> J` <br /> DISTRIBUTION <br /> If the form is completed by the tank owner orhisagent, retain the last copy <br /> and forward the remaining copies intact to your local tank permitting agency <br /> distribution. <br /> Original - Local .Tank Permitting Agency <br /> ` 2. State Water Resources Control Board, Division of Loans and Grants, <br /> Underground Storage Tank Program, P.O. Box 944212, Sacramento, CA 94244- <br /> 2120 <br /> � Regional Water Quality Control Board <br /> ✓4. County Board of Supervisors or designee to receive Proposition 65 <br /> notifications. <br /> 5. Owner/responsible party. ' <br />