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' UNDERGROUND STORAGE TANK CLEANUP FUND PROGRAM PERMIT WAIVER REQUEST . CLAIMANT WESTERN OIL & SPREADING INC CLAIM NO 12815 SITE ADDRESS 19256 HWY 99 N,ACAMPO ' Claimants who were subject to the permit requirement but faded to comply by January 1, 1990,can request the State Board to waive the requirement as a condition for eligibnitry 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 S 10,000 of eligible corrective action costs before Fund coverage begins I, WESTERN OIL & SPREADING INC,hereby request the State Board to grant a permit waiver To qualify far the waiver, I amsubmitting the following documentation I The claimant was unaware of the permit requirement pnor to January 1, 1990, and there was no intent to avoid the permit requirement or the associated fees Documentation On the Imes 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 requu-mg a permit to own or operate the USTs 2 The claimant has complied with the financial responsibility P p ty requirements of Section 25299 a 1 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 claun 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 ofthe claim apphcation, attach evidence that the USTs were removed, the local regulatory agency ' notified,and a copy of the required removal permit_ 4 The claimant has paid all UST fees imposed by Section 25299 41 of the H&SC due on and after January I ' ]99l Documentation 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 Fee Return Form filed with the Board of Equalization with ' proof of payment (For further information on this form, contact the Fuel Taxes Division at(916)322-9669 ) ' Print Claimant Name Sign Claimant Name iNote Mail completed `Permit Waiver Request' and documentation to the address on the cover letter 1 Recycled Paper Our mission ato preserve and enhance the qualiry of Co!forma s+voter resources and C7 ensure their proper allocation and eluent use for the benefit of present and future generations