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INSTRUCTIONS "A" <br /> GENFRAL INSTRUCTIONS: <br /> 'SECTION 2711 OF TITLE 23,CHAPTER 16,CALIFORNIA ALIFORNIA CODE OF REGULATIONS ANIS SECTIONS 2,5286,2-52S7.AND 25289(:}F CHAPTER <br /> 6.7,DIVISION 20,CALIFORNIA HEALTH AND SAF"ET"Y CODE REQUIRE OWNERS TO APPLY FOR AN CST OPERATING PERMIT. <br /> I. One FORM"A"shall be completed for all NEW PERMIT"CHANGES or any FACILITYISITE INFORMATION CHANGES, <br /> 2. SUBMIT ONLY ONE(1)FORM"A"for a Facility/Site,regardless of the number of tanks located at the site. <br /> 3, This form should be completed-by e>ither fhc ERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANK INSPECTOR, <br /> 4. Please type or print clearly all requested information, <br /> 5. Use a hard point writing instrument,you,are making 3 copies. <br /> 6. Tank owner must submit a facility plot plan to the local agency as part of the application showisig thi lcscation of the UST's with respect O <br /> buildings and landmarks[Section 2711(a)(8),CCR], <br /> . Tank gAilaermust subr�til,documentalion showin eom liance with state financial responsibility requirements to the local agency as pearl of the <br /> application for petroleum USTs[Section 2711(a)(I I),CCR). <br /> TOP OF FORM:"MARK ONLY ONE ITEM' <br /> Mark an(X)in the box next to the item that(rest describes the reason the form is being completed. <br /> T. FACILITY/SITE INFORMATION&ADDRESS(MUST BE COMPLETED) <br /> I. Record name and address(physical location)of the underground tank(s). <br /> NOTE: Address MUST have a valid physical location including city,state,and zip code, <br /> P,O.BOX NUMBERS ARE NOT ACCEPTABLE, <br /> Include nearest cross street and name of the operator. <br /> 2. Phone number must have an area code. If the night number is the sa€oe,tvvrYte ISAX'IE'"irt-proper location, <br /> 3. Check€he appropriate box for TYPE OF BUSINESS OWNERSHIP(ex.,CORPORATION,IN151VIDUAL,etc.). <br /> 4, Check the appropriate box for TYPE OF BUSINESS, <br /> 5. If Facility/Site is located within an Indian reservation or rather Indian trust Iands,check the box marked"YES". <br /> 6, Indicate the NUMBER of TANKS at this SITE. <br /> 7. Record the E.P.A.ID#or write"NONE"i <br />