SITE INFORMATION AND CORRESPONDENCE FILE 1

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,4 UNDERGROUND STORAGE TANK CLEANUP FUND PROGRAM PERMIT WAIVER REQUEST CLAIMANT : ROGER HUCKINS CLAIM NO . : 012186 SITE ADDRESS : 1201 CENTER ST S , STOCK`hON Claimants who were subject to the permit requirement but failed to comply by January t , 1990 , can request the State Board to waive the requirement as a condition for eligibility . Where the State Board grants the waiver, the level of financial responsibility (deductible) is twice the amount otherwise required . In this case , the claimant will be responsible for the first $ 10 , 000 of eligible corrective action costs before Fund coverage begins . jj I , ROGER HUCKINS , hereby request the State Board to grant a permit waiver . To qualify for the waiver , I am submitting the following documentation : I . The claimant was unaware of the permit requirement prior to January I , 1990 , and there was no intent to avoid the permit requirement or the associated fees . Documentation : On the lines below , provide a brief history of the underground storage tanks ( USTs) and an explanation as to the reason why the USTs were not permitted by January 1 , 1990 . Explain when and how you became aware of the law requiring a permit to own or operate the USTs . 2 . The claimant has complied with the financial responsibility requirements of Section 25299 . 31 of the Health & Safety Code (H&SC) . Documentation : Attach a copy of the Certificate of Financial Responsibility that is on file with the local regulatory agency . 3 . The claimant has obtained and paid for all currently required permits . Documentation : If you owned or operated the USTs at the time of submitting the claim application , attach a copy of the permit to own or operate the USTs or a copy of the application indicating you are diligently pursuing the acquisition of the permit issued by the local regulatory agency . If the USTs were removed prior to submittal of the claim application , attach evidence that the USTs were removed , the local reeulatory agency notified , and a copy of the requited removal permit. 4 . The claimant has paid all UST fees imposed by Section 25299 . 41 of the II &SC due on and after January I , 1991 . i Docutnentatiou : If any of the USTs owned or operated had product placed in them on or after January 1 , 1991 , attach the most recent copy of the UST Pee Return Form filed with the Board of Equalization with proof of payment . ( Por further information on this form , contact the Fuel Taxes Division at ( 916) 322-9669 .) 6 Print Claimant Name Sign Claimant Name { Note : Mail completed " Permit Waiver Request " and documentation to [lie address on the cover letter . [i .i i Rer,,yh d Allow Our r„r, is to t, erne and en <„r<e the ,rr,,dry of e idi fit trills itn,•r resources, and eirswe their proper al1rrc,rrrr„rrrrrd ,•mrierrruse fill- the ne,reirrofnrc „ rrrand rrrore ifenetarlwiv