COMPLIANCE INFO_1987-1995 - Laserfiche WebLink

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INISTRUCTIONS FOR COMPLETING FIRM "All GENERAL INSTRUCTIONS: SEC.T'If_�11 2711 ill,,I I LI 23,Ci IAI?"i'T'R 16,nC`ALIIrORNIA CODE DE OF REGULATION'S AND SECTIONS 252gta,25287,Alii) 2.5289 O C HApE`ER 6.7,DIMS O 2ID,CAt.li�OIR—NIA lIFALTTi AND SAFETY C ODE REQUIRE OWNERS TO APPLY'FOR AN UST OT%liRATI G PL"RMEF. I: One,FORM"A„shall t e completed for all N E W PERMITCHANGES or any FAC1LITYISITFI ItNFORMA'ITON CIIAIaGIs, 2. SIMMITONLY ONE(1)FORM "A"for a Facility rSitw;,regardless of the number of tanks located at the site. 3. This form should be cinirltleted by cithu� the PERMIT APP11CANT or theL ..AL AGENCY UNDI::RGRCIUND TANK INSPECTOR 4. Please type or print clearly all requested infuranation. 5. Use a hard point writing instrument,you are.making 3 copies. 6. Tank owner must submit a facility plat plana to the local agency as part of the application`showing the location of the USTs with aspect to buildings and landmark's[Section 2711 (a)(£3);CCRI. 7. Tank owner must submit€ocumentation showing compliance with state financial responsibility requirements to the load,agency as Int ofthe application for petrolcurn UST&[Section 2711 (a)(11),CC,RJ TOP OF FORM "MARK ONLY'ONE ITTNA- Mark an(X)in the box next to the it.era that gest descritzes the reason the fonn is being completed. L FAClI.JTY/S!TE INFORMATION&ADDR .SS(MU S 3fb C:ONIPL T'ED) 1. Record name and addtcss i(physic tal loo atiou)of the underground tank(s). NOTE-. Address it$iaST have a valid physical locatton includling city=,state,and zip Code.' Include meanest c least stere ut snd mr-su of the op:rator_ 2. Inh«nU ntatrthc r ranust have an area code, 31 c?rc n6ght na,.ax;r is the same,write"SAME"tai proper Isscttttcm. 3, Check the appropriate faux for T°Y111i OF BUSINESS OWNE SHIP ex.CORPORATION,INDIVIDUAL,etc.). 4. Check the appropriate txsx fear TY11F OF lit SZN13SS. S. l€f=az<,1tEg_gift is Irk atcd"Within an Ind..n=a re�ervaUu",or other ir:d£razt trust lands,check the box marked"`t E,S . fa. Indicate the NC't1I31;