|
INSTRUCTION'S IPLEI
<br /> GENERAL INTI2U&IONS; ;
<br /> SEC'"I ION 2 711 C)1 'i t"I`LIa,23,a 1AP-I ER 16,CALIFORNIA C ODE OF REGULATIONS AND SECTIONS 252 6,25287,AND 252890F CHAPTER
<br /> 6.7,DIVISION 20,CALIFORNIA lsAI11I AND SAI ETY CODI REQUIRE OWNERSTO APPLY FOR AN i.S1 C)PTaRr1'I"ING irf:RmIL
<br /> 1 erre I bRM"A"shall be completed for all N EW PERsihh CHANGES or any FACILITY/SITE INFORMATION'CHANGES.
<br /> 2. aIII3�tI"i"C3�tldY C3E E(1)FORM"A"for a Frachity/Sate,regardless of the number of tanks located at the sife,
<br /> 3. This farm should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY tsNI3F.TtCsIZt)I:t'AD TANK INSPECTOR.,
<br /> 4. Please type or print clearly all requested inforntaation,
<br /> 5. Lim a hard paint writing instrument,you are making,3 Copies.
<br /> .
<br /> Cs. Tank owner roust submit.a facility plott
<br /> phh ri the local ageney as partof the application showing the location of tie 17S`1's evrth'iiqpent to
<br /> bud'lding;s taste#laandmarks(Scetican 2711 (a)(a3) C:CRd ',
<br /> "7. Tank.owner must submit documentation shrvvin'�b n;Cliatce,*i e state financial responsibility requirements to the locaal ag aicy as part o4Ahe. ,
<br /> application for p trolcuin USTs[Section 2711(a)(I 1),CCRj,
<br /> TOP OF,FORM:'MARK ONLY ONS,ITEM"
<br /> Maack an(X)in the box next to the hent that best describes the reason the fono is beim completed,
<br /> T. FACILITY/SIT[:INFORNIA`I ION&AI)DR .SS(b.,4UST BE C'f Ml'l:l;"CED)
<br /> 1, Record name and address(physical location)of the underground tank(s).
<br /> NOTE: Address IMUST have as valid physical location including city,;state,and zip code
<br /> P,O} 13OX:til%:b4BERS ARE NOT ACC;I lyrAI3LE.
<br /> Include nearest crass street and naarac of the oporaator.
<br /> 2. Phone nurnber anust have an area couc, If the night number is the same,write"SAME"in proper locaaticxt.
<br /> 3. Check the appropriate bvs for TYPE OF BUSINF.SS OWNERSHIP{c x,CORPORATION,INDIVIDUAL,
<br /> { d.
<br /> 4. Check the appropriate Ix?x for TYPE OF I§t,SII SS,
<br /> 5t If I acifaty/Sire is to au'd within an Indian msr:r."ation or other Indian trust laatda,ci'aeck the box sharked"YI;S".
<br /> 6. Indicate the NUMBER ol'I'A ek.S at this SITE,
<br /> T'Rec:ord the E P.A..I1)#or write, NONE"in the space,pu vided.
<br /> Complete all iwrns in this sectio€a,unless all iterns are,the sarne as SFC'l1ON 1,If the same,write"SAINI AS SITE"E"across this section. Be sure
<br /> to check 11ROl'llR Y OWNERSHIP'C"YN1a Lox.
<br /> TILTANK OWNER INFORMATION&jADDR[SS(—NII/ST BECOMPLETED)
<br /> complete all iteral»iil t`is section,unless all atatiias are the same as SECTION I;"If the s4xrc^Write''rs A�L�, S"Shli�"Alois atis Sc�ticn,',kTZ usta�e
<br /> to.ehec:k TANK()1ArNERS"i YPL,box.
<br /> IV,I3O.1,n)C)1 Im1OlAI_T'.7.A oN,uS t S`i ORAG ,IEE,A€.,C OUN'I'NUMBER(S'tt?S`I'13E"C<?MPL'ETED SEE ARTIC11, a,C Il AP T I'W6,75, '
<br /> DIVISION 20,£ 1 .EIORNbilLTH AND SAFETY C".ODYL)
<br /> Enter vocal Boardof Equalizalion(OXA;')t ST stpragc lee acc cont number chick as required twfore your p Smut alb licafa,,n c,"ot 4x,l rooms.:d,
<br /> I?:°g tr.t.aatit>n with tlr ti{)1:v iii{�s.ct,. its y.>x=a£:11 r, eine a arterly Storage fee rc turn in repcsginT the,�0,0)O(6,w�il a a r,;a i ar,fce.ducon
<br /> on the
<br /> uaula� ,>f gaU s,<pa ,,'d in yo'lo-�.s.;..!nw '301- w all c aa�; rsoats exurnpt ft'otn p,a) ng,,the stor:r t sct't ?a.r.klrs.I.ac F sr �att.�Tf 4<<x.'ofc>last
<br /> h—vc an'aa c u at w mcr 5,iOh th. BOE ort you ha ti any ctucs6ona regalding the Tea ore :xagatrt,ars,plea.,t,call t,aW_ir>t<<., „f 1 r60) r wroc
<br /> to i,aa,tTaalS tat t1, la> is c,..a a:ld-Ss Board.. Vic`zk t >zt;T a„I latxes I)as imon,11.0.I3o�,942,)s'79,Saar r.a.r,e at 9,CA 9
<br /> V. I'l;TiCC)LULI':i-UeS1'1-1 NAI AL lli.SPONS;i'>e.'3"i'y' ,y z' ST tlt.:£OMW1,l<al':
<br />
|