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y <br /> x/1994 20:1091653582c78 APE{ EWZROTECH �.I PAGE 02 <br /> State Water Resources Control Board <br /> Underground Storage Tank Cleanup Fund <br /> {� AUTHORIZED REPRESENTATIVE DESIGNATION <br /> CLAIMANT(S): { �r`�ora�� �{ U�v� CLAIM NO. 3 O <br /> ME ADDRESS: <br /> The above Identified clairnant(s)do hereby jointly and severally, appoint: <br /> AUTHORIZED REPRESENTAME: o <br /> ry <br /> Company Name and Address: ypeM nt Name) <br /> J <br /> L# <br /> AUTHORIZED REPRESENTATIVE: <br /> Company Name and Address: . (TypeRrint Name) <br /> to sign and file any and all documents necessary to apply for relmbursement of corrective action casts from the Underground <br /> Storage Tank Cleanup Fund Program for the site identified above. <br /> Any action by the above-named authorized repre5entative(s) 1s for us and in our name, place, and stead, and for our use and <br /> benefit. <br /> We hereby agree and further authorize the above-named authorized repcesentative()to certify that all applicable state and federal <br /> statutoryand regulatory requirements pursuant to Chapter 6.75 of the California Health and Safety Code,and Chapter 18 Petroleum, <br /> Underground Storage Tank Cleanup Fund Regulations, California Code of Regulations, have and will be complied with. <br /> The signature of the above-named authorized representative(s)is binding upon all claimants party to the above-identified claim. <br /> This.Authorized Representative Designation shall become effective on the date of execution and shall remain in effect until <br /> terminated, In writing, by the above-named cl2imant(s). <br /> Executed This a [lay Of --)71)1 19C'- <br /> At ,California <br /> C[a: t Sign ur Printed Name �r <br /> C fmant signature <br /> 1Prin�Narp1— <br /> Au od Repr ntativeSignatu <br /> ra 7FriaNa <br /> � � <br /> Authorized Representative Signature <br /> Printed Name <br /> E ± 161T 3 <br />