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-'4'11l1'(J-4N-08-'98 THU 08:58 '- TESORO TEL N_O:209-464-7066 4629 P07 <br /> 4 <br /> EPA 11) <br /> 1t K)X hitoltr iPIPiAIY <br /> CUL AaWJXWCR RpQ <br /> gatt:on is for a4 Off.or U 1T8, <br /> Coatlltional Autho`ty a n w O����w=bro f M• owner or o_ FTU, ora generator o <br /> 11tic 22, CCR h9 is�jgLbL t i i e for an Pera[or of <br /> section 67450.13(e). If you aro tae oettam n cx nption fro Derating Pumuaot to <br /> assurance, Please See iasttuctloa For tinanalal assurance a great of <br /> this section. Whets You quality for an eselnp exemption 110111 s Pursuant to <br /> Df t <br /> aeanXMbtr <br /> Titre zz' ccs on for this section. <br /> assuratice, please gee instru9tl <br /> Please check the appropriate boxy <br /> 1, As a'M owner or operator or FW owner or operator, I have not operated more than tlli[ty days in a <br /> calendar year. under PBR to be eligible for the 30 day <br /> If box (1) is m�ed1 Your treatment on <br /> must be operating <br /> t' thorirattow are not eligible for this exemption. <br /> Note: <br /> exemption' Gen rulers operating under Condidonai Au <br /> Be sure to sign the owner or operator certification below. <br /> ] 2. I am required to provide a mechanism and it is attached to this form. <br /> Note: it box (2) is marked, you must complete ail sections of this form (al5v <br /> the owner or operator certification below. <br /> I am not required to provide a mechanism' Specify why:_� <br /> j Note: - Ir box (3) is marked, please sign the owner or operator certification below and attach your self- <br /> certification letter to this roan, <br /> OWNER OR OPERATOR CpRTMCATION: <br /> '1 certify under penalty of law that this doeument and all attachments ware p'lely rt under evaluate <br /> direction in supervision <br /> in accordance with a system designed to assure that qualified persoanal properly gator[and evaluate the information <br /> submitted. Based on my irlquuy of the person or persons who manage the system, or those directly a responsible for <br /> gathering the information, the information is, to the best of my knowledge and belief, true, accurate and compute. I <br /> am aware that there are significant, the mations for submitting false information, including the possibility of fines and <br /> imprisonment for knowing violations,* <br /> NAMM (PRINT OR TYPE) TITLE <br /> i <br /> SIGNATYJP-E RATE SIGNED <br /> PAGE 3 OF J <br /> i CSC 1232(9/96) roomertY 8113(1196) <br />