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JRN-08—'98 THU 08:58 In TESORO , . .,,._,. ., TEL NO:209-464-7066 <br /> 4629 P06 <br /> iho�CWrolnia[?wll(omia l�vho®eaW PlooeetloD Aa�iry Dwuuwm of lbrte Sabsftam[..Dano[ <br /> CERTIFICATION OF FINANCIAL ASSURANCE <br /> FOR PERMIT BY RULE AND CONDITIONALLY AUTHORIZED OPERATIONS <br /> (See Aaae4ed rmebve M) <br /> FOR OFFICIAL LW ONLY <br /> DTW REGIONAL OFFICE <br /> _j <br /> For use by owner or operator of transportable treatment unit,owner or operator of fixed treatment unit operating under Permit <br /> ay Rule, or a generator operating pursuant to a grans of Conditional Authorization. <br /> ❑ Initial Certification ❑ Amended Certification ❑ Annual Certification <br /> Put an asterlt'k In the left margin next to the amended information. <br /> !. GENERAL INFORMATION <br /> A. TYPE OF OPERATION: <br /> ❑ PBR-FTU ❑ PBR-ITU ❑ CA ❑ OTHER <br /> If operation is a TTV, insert 'PTU serial number: <br /> 1 <br /> B. FACILTTY/TTU EPA ID NO: <br /> C. FACILITYr=NAME: <br /> D. ADDRESS OR LEGAL DESCRIPTION OF FACII,TTY/TTU LOCATION: <br /> CITY: CA ZIP CODE: <br /> COUNTY: <br /> E. MAILING ADDRESS: <br /> CITY: STATE: ZIP CODE: <br /> F. CONTACT PERSON: <br /> LAST NAME FIRST NAME <br /> TELEPHONE NUMBER �) <br /> 'TSC 1232(3/96) Formerly 9113(1/96) PAGE 1 OF 3 <br />