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<br /> atsns�a z` ?.rees3 ( ar:, €lrser;?tion) €> ttta: ,ew.<,>so srp
<br /> ",'C3P1"..�6Add t'_,gx'' ass � ���Iid phyma fe,watton i ".,awing 4ty, sietz" and zip code.
<br /> P.0. BOX NU 7IMBl,RS.R RF, aN(X1 'FVFA1 1.F,,
<br /> Intl..% ."urem c o; ..rcest astd name of the opcywor,
<br /> 2" Irtaaane number merit Kne an .area code, If the right ssrmPater is the same. write SAIt1" in prolte.. 1 mation
<br /> 3. Check €Ire a"ropWe Nw for FYIIF €F BUSINL°sS OWNERSHIP (ex. C'0R110F ATl(.)N, Ib1llVlI1iJ,"L Nct )
<br /> E Check the as=xpwpnai, bo Ufa, T'VIIT: OF IIL sr1"si>SS.
<br /> ;S. if = achit/Si w is iU„amd WIN an lsi fiaa€r ,
<br /> mscgreartknt (�, ver F,,�tirea x"r,.. lands, chk ok than hox rtra€6cd `NTS".
<br /> 6. �lmli,`a,4te;. Me ;"+�s..'liS�IT orf':ie�?,�'x�(b�'. 1t this `'RI,"-
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<br /> y 7 I�tc�src€ EhL RAN 1 ) t or axis ';')iI lar my ~alta c I a o tart
<br /> OVN�FR .°FOu, I"It& I;st,
<br /> (,€r,.pEt all ,tc; . in this swum, umdsa aiC nale are the aex«"a6 S ,C Tl tC },.i!`°:ita�.'same, al toss
<br /> 1his 1Sr r,.a ch,,-,ok r,f"C fr Kos'a' 0yy'?'sFRS11I6' Ss1aa _ax%,
<br /> III. TANK C? I'dEM I?I rORMA'11{tx""a & ADF)Ryigs (MUSr III:; {..CiI,Alsi.i"VD)
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<br /> CmTlam ail itet,rs in MA oonion, un ss aH a;c.nac axe the zani as ;r1,C°3:iE;N 1: 16t` e aarh scr-sfc'".`AMF,,A,� 4C"1I�< a s°rtes
<br /> ME sc..•thm -1c.. .,we to r,,eck IAaNK OWNTIM SHIP"I: `PI,hm.
<br /> IT BOARD t:5i< 1X)LlA1,TZ.N1`l0 t.?, B°6a1'C)WNGE 140 AC C(IJITI' NUMIAiR (NIIJS`1°`131; C"C) puri11.3
<br /> I;sttct your I$hasrcl of I tlt<x4`szati<yst'((>{'tT`s)
<br /> IRT sir he Cee aaccoaar.t .sut mor which is required before, your pcinih'a p0c'aii0h
<br /> reran be prtaemsed. Reostration with the BOE v+M ensnare that you will receive a quarterly storage fee return in cel,or[in, thea
<br /> $1006 (6 ant lha) per gaHon Be due an the number of gaHons phee°d in your L.S'Fs. The 73C:)ET MH conic personas exempt dam)
<br /> paying the storage tee so retams will nor be sm If you cif, not have an acc'€Vt number vith they 130F,' or ir you hwe ,arty
<br /> spasastims rcgandng Me Be or ercnmp dos:>, please call the 13t:1ia" car 91,602:30555:<g1tim to the I3OE at Me 1'asllcrrar`ny hAiress.'
<br /> Board of Eklu alaration, TinvixcrnnrenlaYftcas Unit, PD, Box 912879, Sas raamcnto, _94279-00CI1.
<br /> V. 1IFFRC7LFU S]' FINANCIAL RESPC➢NSII31111-Y ( 1T 1' 31;
<br /> Identify fine metho (s) =4 �ytne_n�mer arad/or,.n*rotor in
<br /> meeting the edcrai"and State financial responsStrility
<br /> requirmne,nm USTs ownetat las"any Federal or State agency are c;enipat from this requirement.
<br /> VI. 11-tGAL N(XrII'1C r"I"I0N AND 11IIr JW';ADDRE&S
<br /> Check ONE FQX for the aaddrr s that will be used in ]3L>T11 11fGAL.AND 13111ING N01114(wIl NS.
<br /> PP11C M1` MIa,9I7 C1 r`yND 13AIE'fTE R)I I AS I DIGITTI1.
<br /> IN,S]IRIXTION 1100, a LC CCA: CI11,NC"IIyS
<br /> `I'e county and jurisdiction nutnber°.s are predetenm ud mW mn he ,1 E.xsi ed by c0ing the State 13oat"d (916)739-2421.. The
<br /> facies, sz m er may be ns__4 d by the local agency: however, IN nwn%r rsaa st be numerical and cannot Contain any
<br /> 01 tiaslwiK. If dere ➢sat aqw, r mf..rs Me 'Swe Board to m gn Ow f"a"ll s3° number; please leave ie himik.
<br /> T'.1, ICS"1,I E ITr6PI1 1SII3iID'Y OF111H 6.11(:'. f. tt(UNCy a a I'`c r JbIR"I.C11S 1111' FACI1 rFY TO VERIFY111L,
<br /> e`4C'(,'IJRA(CY C 1a it INIrS:)RItVI'10 , `ITTIS API11,ICx,Vl10N GANN(X1" BE PICC>C;HsSED F'11JEE'ACCOlwr
<br /> NUMBER IS bKYF 1411113 IN. 111H,LOCAL AGENCY IS IIESPONSIALE reit.`.11€11 C OMPLF,'110N 01111111
<br /> 11113
<br /> *TJC)(AL AGENCY Y USE, 0P IN' 1NFLAIC °:10N BOX 6ND 1aC1I's FORWARDING ONE K)ICh1 *A* AND
<br /> A K)K;I I I) JQRNM "I3^( ' r 1711F,VOTIK> &4 AT)DRi?,R& u,
<br /> OF 0NLIFORNIA
<br /> SI: 1? V4AIER IIT-"sK)U C KS CONIROL BOARD
<br /> DATA P OC ;,S.S C1 CENIT
<br /> PD. BOX 527
<br /> PARAMOIJKF, CA W03
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