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JAN-08—'98 THU 08:58 ID:TESORO . . .. _,. _. TEL NO:209-46a-7066 4629 P06 <br /> iref CallaiadaL�llfom4 t�vhoameatal Praeeedoe Dopa1toon1 of ibsle S Wmooas Coanat <br /> CERTIFICATION OF FINANCIAL ASSURANCE <br /> FOR PERMIT BY RULE AND CONDMONALLY D OPERATIONS <br /> 9PR{E.Tar.�_S.ar. fSeeAaa4ed6utrwynnr) <br /> FOR OFFICIAL USE ONLY <br /> t <br /> Dn C REGIONAL OFFICE_ <br /> For use by Owner or operator of transportable treatment unit,owner or operator ra �init <br /> unL Permit <br /> Dy Rule, or a generator operating ptuattam to a grant of Conditional Anthorizati <br /> ❑ Initial Certification ❑ Amended Certification ❑ Annual Certification <br /> Put an asterisk In the left margin next to the amended information. <br /> !. GENERAL INFIORMATION <br /> A. TYPE OF OPERATION: <br /> ❑ PBR-FTU ❑ PBR-TTU ❑ CA ❑ OTHER <br /> II operation is a TTU, insert TTU serial number: <br /> 1 <br /> B. FACILtrYfI`TU EPA ID NO: <br /> C. FACILITYPrTU NAME: <br /> D. ADDRESS OR LEGAL DESCRI]MON OF FACILITYrM 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 /> ?SC 1232(9196) F-r-erly 6113(1196) PAGE I OF 3 <br />