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INS17RUCTIONS FOR COMPLEYING F'OR!'A 'A'
<br />GE-Trall- RAJ', INS, FRU(,'IIONS,
<br />fe,,� ail NEW P1,75th1rIN, Pt
<br />S
<br />�Y vy Q& N 0�1"Hu,
<br />2. kHMP,- ONLY ONE,' (1) FORM '' f_: a )ofli hy/Sitc, rets art:
<br />3, 1'his loom shmad is u7;n0eint! by chher the SSI, :t' APPIK'
<br />TANK INSPFCTOR
<br />4, Phrum type or pHnI Wcay all wqmWd KKM=thn
<br />- 14C j had pnis� ,vr4ing, nns,�,,-,tmtntt, you �,,,,,z making 3 copics,
<br />TOP OF Ff1'fR"',4,: 1z1AR)-,' CINLY ON'1,,
<br />AW mi qX) in the box next to the hem that bw desuibes Be mm
<br />1. FA(,31XJ-Y/SrI'H 1N'FCvR2VA-170N & ADDRIeSS, (MUSr BE COMPLf-,17
<br />L Rucut r„ el. and aMwo 0%yskal humo 4 Me u0ergour:
<br />AAUE: Anklmss MUST have a valid location
<br />1,1,0. BOX NUMBISCS ARE, NOT ACC1EFJABU-
<br />lacludc titeoe�st cross, street and wme of the open or.
<br />Z phw� nunrhcr nnusz have, art areaode- 3i` Mc night number is
<br />hecA the appreprime b(ts x", r" OF B(.`S1Nl-,'SS OWNRS
<br />E
<br />1, C'h,,�ck approrm"ac hco, for 'I"YPE OF', " '-,'Sl . f,`Ss,
<br />I if Welty/Sks is focau,,d w�0,tin an, Indian reservation or otb" I
<br />6, o
<br />lvdicotc, the f'i',"iNKS at this SITE,
<br />R'�-otrd the, IL) 14 oc write `NC)NT-,in the space providet
<br />HE PROPEXIN OWNER, INPORMA110N & .1VT)DRE-sS (MU,5r Br,. mmi
<br />cmwkw A H"M in MA Odom Own au Renz am me sune as is
<br />ME secriom Be sum to dwck PR(Alf.-JUY (,')WNf-,.-RSIIIP TYPE k�o
<br />HL TIANK OWNER INFORMATION , ADDRESS QYUJIS'l' BE COMPLY -4,31
<br />C,omytliete af! iterns in uhs� section, uk�ss ill iicrns are the Baine 4Is
<br />this Be sure �,o chte�k TANK 0WN,[,R.S1J1PTYT9B box,
<br />14 EVINRI) (A' IXTUAlIZA110N USI'SF0RAG.F,'I1EF, ACCOuhrr Numi
<br />F,mci- your Buard oflopualhe;tun (1101 ) U'51' %rorage fee account m
<br />can be processed- Po
<br />nmrauop vvah the BOE will ensure that yoe ,v
<br />'S)A6 16 vnHh) per gallon fee due on the nuoflu'r of shots placed i
<br />peiying the sto,iage fee so, returris will not i)c Ont. If yOU 410 not Ila-,
<br />qticsborad, regarding unt As or enrapAmn pkause ull Me BOB al 91
<br />Bo
<br />i ard. cf f---',,,tuf,dSafi tom, Fees Ulnii, P,O, Box 942879, Sr
<br />it PHITIUMMUM LJN1'F1NANCM—kL RUiSPONS11111IFY Rvamr an cmmp
<br />WcAV tim awthodbu) tmed by We carrver md/or oymuttor in rneethl
<br />reqAeracras, USTs rovned by any Fedend or Svatc agenq are exem
<br />VL LECIAL l!V(Y11F(QVl1()N AND 13,113.1 -NG, ADDREi-I's
<br />t.sFrwiuONE, BOX for the address MM AN he az ed for 13UFEI 1XlC
<br />APPUCANU MC: ST ANL) DX11,111F, FORM AS ININCATEIS.
<br />IT ,1317 FOR THE, U)CAL Aex ENK11"tS
<br />'I'lu, counry and jurisdiction non Vi are presictcrmined and can be n
<br />fa6fiEy nurnber rnay be t3 sign,, by the locni qpncy; however, this nu
<br />mpbabefir.m. If the ,o vat agancy prebrs Me &me Board to asst n A
<br />ril is 1111131 ICI SPOppQ1,1011IT 01,131TV LOCAL AGENCY'111A'17j
<br />ACC'URACY 011111EINIFURMADON, THIS APPIKA710N CA
<br />KRAVIBIA IS POYF FILLEU) Ila", LOCA 1,AGIINCY IS Rf!-SP(
<br />�IWM AfITTMIAT YIQWZ 4-IN4 V- WW ANMI TTITY
<br />IWI -IF CALIFDRNIA
<br />SI W.,V11dR RESOUR(AIN awrRE4
<br />pro, smxxp,&
<br />DALA PROCESSING GATIVER
<br />11'a BOX 527
<br />0A0Ak99'1Y',-KrP x'A CVt7r`1
<br />
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