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Q-Aip" <br /> EDMVNO G.BROWN JR. <br /> GOVERNOR <br /> 00 <br /> C•L 1 F O 11 M 1♦ )\ dT �. ti MATTHEW RODRicuu <br /> ENSECRETn Rv FOR <br /> Water Boards <br /> ENVIRONMENTAL PROTECTION <br /> State Water Resources Control Board <br /> September 17, 2012 <br /> WEST CLAY PROPERTIES KNIFE RIVER CORPORATION <br /> DAN SILVA c/o MR BOYD CLEMENTS <br /> P O BOX 6152 P O BOX 6099 <br /> STOCKTON, CA 95206 STOCKTON, CA 95206 <br /> UNDERGROUND STORAGE TANK (UST) CLEANUP FUND (FUND), ASSIGNMENT <br /> AGREEMENT, CLAIM NO: 008542, FOR SITE ADDRESS: 639 CLAY ST W, STOCKTON <br /> The California Underground Storage Tank Cleanup Fund (Fund) has reviewed the Assignment <br /> of Reimbursement Rights to the California Underground Storage Tank Cleanup Fund <br /> (Agreement) for the above-mentioned claim dated June 17, 2011. Per the Agreement West <br /> Clay Properties becomes the Assignor and Knife River Corporation becomes the Assignee. <br /> The Fund will recognize the effective date of the assignment as of the last date the Agreement <br /> was signed, June 22, 2011. <br /> Upon review of the documents it is determined that the following information is needed before <br /> the request for Assignment can be processed: <br /> 1) Completed Assignee Status and Certification form: <br /> 2) Completed Assignee Conditions of Payment Certification form; <br /> 3) Completed Assignee Non-Recovery From Other Sources Disclosure Certification Form; <br /> and <br /> 4) Completed Assignee Claimant Data Record form. <br /> Please note, all documents must have original signatures and cannot be submitted via e-mail. <br /> As a reminder, it is an unacceptable practice to sign blank form Reimbursement Request <br /> forms for someone else to fill-in and send to the Fund. <br /> Please send the requested information to: <br /> Kelli Garver, Settlements Unit Claim Number: 008542 <br /> State Water Resources Control Board <br /> Division of Financial Assistance <br /> 1001 1 Street, 171h Floor <br /> Sacramento, CA 95814 <br /> CHARLES R. HOPPIN,CHAIRMAN I THOMAS HOWARD, EXECUTIVE DIRECTOR <br /> 1001 1 Street.Sacramento,CA 95814 I Mailing Address:P.O.Box 100.Sacramento.CA 95812-010D I www,waterboards.ca.gov <br /> L1 RECYCLED PAPER <br />