COMPLIANCE INFO_1992-2000 - Laserfiche WebLink

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INSTR*TIONS FOR COMPLETING PRM tt At' GENERAL INSTRUCTIONS: SEC11ON12711 OF TITLE 23,CHAPTER 16,CALIFORNIA CODE OF REGULATIONS AND SECTIONS 252",25287,AND 25289 OF CHAPTER 6.7,DIVISION 20,CALIF0RN IA HEALT'li AND SAFETY CODE REQUIRE OWNERS TO APPLY FOR AN UST OPERATING PBRwn 1. One FORM"A"shall be completed for all NEW PERMIT CHANGES or any FACILITY/SITE 1NFOR.MATION CHANGES. 2. SUBMIT ONLY ONE(1)FORM"A"for a Facility/Site,regardless of the number of tanks located at the site. 3. This form should be.completed by either the PERMIT APPLICANT or the LOCAL AGEsNCY.UNDERGROUND,TANK INSPECTOR. 4. Please type or print clearly all requested information. 5. Use a hard point writing instrument,you are making 3 copies. 6. 'rank owner must submit a facility plot plan to the local agency as part of the application showing the location of the USTs with respect to buildings and landmarks[Section 2711(a)(8),CCRj. 7. Tank owner must submit documentation showing compliance with state financial responsibility requirements to the local agency as part of the application for petroleum UST's[Section 2711(a)(11),CCRj. TOP OF FORM:"MARK ONLY ONE ITEM" Mark an(X)in the box next to the item that best describes the reason the form is being completed. I. FACILITY/SITE INFORMATION&ADDRESS(MUST BE COMPLETED) 1. Record name and address(physical location)of the underground tank(s). NOTE: Address MUST have a valid physical location including city,state,and zip code. P.O.BOX NUMBERS ARE NUT ACCEPTABLE. Include nearest cross street artd name of the operator. 2. Phone number must have an area code. If the night number is the same,write"SAME"in proper location. 3. Check the appropriate box for TYPE OF BUSINESS OWNERSHIP(ex.CORPORATION,INDIVIDUAL, 4. Check the appropriate box for TYPE OF BUSINESS. 5. If Facility/Site is located within an Indian reservation or other Indian trust lands,check the box marked"YES". 6. Indicate the NUMBER of TANKS at this SITE. 7. Record the E.P.A.ID#or write"NONE"in the space provided. IL PROPERTY OWNER INFORMATION&ADDRESS(MUST B1:COMPLETED) Complete all items in this section,unless all items are the same as SECTION.1;If the same,write"SAME AS SITE"across this section. Be sure to check PROPERTY OWNERSI1111 1'YPE box. Ill.TANK OWNER INFORMATION&ADDRESS(MUST BE COMPLETED) Complete all items in this section,unless all items are the same as SEC—TION 1;If the same,write"SAME AS SITE"across this section. Be sure to check-TANK OWNERS TYPE box. IV.130ARD OF EQUALIZATION USI'STORA(;I FEE ACCOUNTNUMBER(MUST BE COMPLETED.SEE:ARTICLE 5,CIIAPTT R 6.75, DIVISION 20,CALIFORNIA HhALT]t AND SAFE 1'Y COI)I:,) Enter your Board of Equalization(130Ei)UST storage fec account number which is required before your permit apj,licatlon can be processed. Registration with the BOG will ensure that you will receive a quarterly storage fec rewni in reponing the$0.006(6u)i11s)per gallon fee due on the number of gallons placed in your USTs. The BOE:will code persons exerrtpt from paying the storage fee so returns will not be sent. If you do not have an account number with the BOE or if you have any questions regarding the fee or'exemptions,please call the.1301::at 916-322-96(19 or writs to the BOG at the following address Board of.Equalization,FuelTaxes Division,P.Q.Box 942879,Sacramento,CA 94279-OW] V. PETROLEI;.X-1 USTFINANCIAL RI:SPONSIBILTCY(MUST 131-,(X)_NIPLETED FOR Plz m0E,EUM USCS ONLY,SiiE?SIsC'1 IONS 2711 (a}(X) OF TTT'LE 23,CHAPTER,10,CALIFORNIA CODE:Oh REGULATIONS) Identify the mcthod(s)used by the owner andior operator,in meeting the Federal and State financial responsibility US7's owned by any Federal or State agency as well as non-pctroll unt USI:s are exempt frrnn this requirement. VI.I..EGAI.\07T1'ICA'f10\ANI)BILLING ADD MESS Check ONE BOX for the address that will be used for BOT 11 LEGAL AND 13I1,1..LNG NO'hIhECA*l IONS. TANK OWN UR OR AU I10RIZE.D R1:I'REIS ENTATTVE MUST SIGN AND DATE TTIti FOECM AS INDICA I E1). ;SIL.S1 C,t i0NS'27t i (a)(13)OF TITLE 23 CHAPTER 16,CALIFORNIA CODE OF REGULATIONS.] INSTRUCTION FOR TI IE LOCAL AGL:NCIES The county an jurisdiction numbers are predctemtined and can be obtained by calling the State Board(916)227-4303. 'fTte facility number may he assigned by the local agency;however,this number must be numerical.and cannot contain any alphabetical characters. If the kxal agency prefers the State Board to assign the facility number,please leave it blank. IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCURACY OF THE INVORM ATTON. Ti IIS APPLICATION CANNOT BE PROCF,SSED IF THE BOE ACCOUNT NUMBER IS NOT FILLED IN. THE LOCAL AGENCY IS RESPONSIBLE I-OR THE COMPLETION OF THL "LOCAL AGCtiCY USE ONLY" INFORMATION BOX AND FOR FORWARDING ONE FOfthi"A"AND ASSOCIATED FORM"B"(s)TO THE FOLLOWING ADDRESS. THE I.,OCAL AGENCY SHOULD RETAIN T1fE OfUGINALS AND FORWARD THE YELLOW COPIES TO THE FOLLOWING ADDRESS.THE PINK COPY SHOULD BE RET,AI.NED BY T`11E TANK OWNER. FORD12ORI