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Part 1 APPLICATION UNDERGROUND STORAGE TANK PROGRAM BUSINESS Loan Amount Owner Full Address Name of Business Tax I.D. No. Full Street Address Tel. No. (Inc. A/C) City County State Zip Type of Business Standard Industrial Classification Date Business was Established N m I Jf if known: Principal Contact Person & Title: GUARANTORS Last Name (Please Print or Type) First Name Middle Initial Social Security No. Tel. No. Bus. Spouse's Name Social Security No. (Home) Street Address City State Zip Code How Long Age of Dependents Yrs. Employer(s) Firm Name(s) Address How Long Position Yr Last Name (Please Print or Type) First Name Middle Initial Social Security No. Tel . No. Bus. Spouse's Name Social Security. No. (Home) -',eet Address City State Zip Code How Long Age of Dependents Yrs. ,,oployer(s) Firm Name(s) Address How Long Position __-Yrs..- SUPPORTING r .SUPPORTING DATA 1. Personal financial statement for each individual serving as guarantor of the loan. 2. Personal tax returns for each guarantor - last 2 years. 3. Business financial statements (Balance Sheet/Income Statement) - last 2 years. 4. Business tax returns - last 2 years. S. Any supporting documents for equipment, fixtures and labor such as invoices or contracts to be paid with loan proceeds? List the useful life of any equipment or fixtures to be purchased. 6. If loan proceeds will be used for construction. include plans, specifications, and cost breakdown. 7. Legal description of property that business occupies together with full name of legal owner of property. GENERAL INFORMATION CONCERNING -APPLICANT Are any assets held in Trust? Yes,,, No— Are any assets pledged or debts secured except as shown? Yes, No— Have you ever had a repossession? Yes_ No— Have o_Have you ever had a bankruptcy or had a judgment against you? Yes_ No_ Have you ever been a principal or guarantor of a firm that declared bankruptcy? Yes— No— Are you party to any claim or lawsuits? Yes,_,_, No— Has there been an IRS audit in the past 3 years? Yes No_, If yes, has the audit been -settled? Yes_ No_ If yes to any of the above, please explain. I represent and declare under penalty of perjury under the laws of the State of California that this is a true and correct statement of the prospective borrower's current financial condition. Any existing or threatened litigation, claim or circumstance which might reasonably be expected to affect my condition in the future is fully described below or in an attached statement. I will immediately notify you in writing if there is a material change in my financial condition. In the absence of —ch notice, this shall constitute both a new and continuing statement of my financial condition .if I become igated to you or you rely, to any extent whatsoever, on this statement of my financial condition. I agree that my present and future obligations to you may become immediately due and payable, at your sole discretion, if; (a) I, or any guarantor of any of my obligations, at any time fail in business, become insolvent, commit an act of bankruptcy, or die; (b) a writ of attachment, garnishment, execution or other legal process is issued against a material portion of my property; (c) any act for the collection of delinquent taxes is taken against me; (d) any representation to you by me or a guarantor of my obligations proves to be misleading or untrue: (e) I fail to notify you of any material change in my financial condition or there is a materially adverse change in my condition; or (f) I sell or transfer any interest in my current business. I waive the right to notice of any action taken by you in enforcing those rights. You may verify the information contained in this statement with any third party. If you are married, complete all information for yourself and your spouse. You do not have to list spouse's separate property unless your spouse is a guarantor. You do not have to list income from alimony, child support or maintenance unless you want the Department of Commerce to consider it for purposes of the application for credit. I am authorized to submit this application on the part of applicant business. I have reviewed the above statement and understand the foregoing representations and covenants. Date Signed Signature Signature