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"Air INSTRUCTIONS FOR COMPLETING J <br /> GENERAL INSTRUCTIONS: <br /> SECTION 2711 OF TITLE 23,CHAPTER 16,CALIFORNIA CODE OF REGULATIONS ASLO SECTIONS 25286,25257,AND 25289 OF CHAPTER: <br /> 6,7,DIVISION 20,CALIFORNIA HEALTH AND SAFETY CODE REQUIRE OWNERS TO APPLY FOR AN LST OPERATING PERMIT, <br /> 1. One FORM"A"shall be completed for all NEW PERMIT CHANGES or any FACILITY/SITE INFORMATION CHANGES. <br /> 2, SUBMIT ONLY ONE(I)FORM"A"for a Facility/Site,regardless of the number of tanks located at the site. <br /> 3. This form should be completed by either the PERMIT"APPLICANT"or the LOCAL AGENCY UNDERGROUND TANK INSPECTOR, <br /> 4. Please type or print clearly all requested information. <br /> 5. Use a hard pliant writing instrtttrsent,you are making 3 copies. <br /> 6, Tank owner must submit a facility plot plain to the laical agency as part of the application showing;the location of the LISTS with respect to <br /> buildings and landmarks[Section 2711(a)(S),CCR). <br /> 7. Tank owner must submit documentation showing compliance with state financial responsibility re uiren€ents to the local agency as part of the <br /> application for petroleum I.1STs[Section 2711(a)(I ),CCR]: <br /> TOP OF FORM:"MARK ONLY ONE ITE L" <br /> Mark an(X)in the box next to the item that best describes the reason the form is being completed, <br /> L` FACILITY/SITE INFORMATION&ADDRESS(MUST BE COMPLETED) <br /> I. Record name and address(physical location)of the underground tank(s), <br /> NOTE; Address MUST have a valid physical location including city,state,and zip code. <br /> ROt BOX NUMBERS ARE NOT ACCEPTA BLE. <br /> Include nearestcross street and name of the operator. <br /> 2. Phone number arcus€have an area;cede. If the night number is the same,write"SAME"i <br />