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"'4 J1 VJRN-06—'98 THU 08:58 ID:TESORO TEL N0:209-4F^-7066 #629 P07 <br /> ............... LPA 1D) <br /> C• 1TUN 1!RtOM FINAIY� <br /> AMIRANCE I'CF,Q <br /> T►�+=tion is for as o Sr <br /> Conditional Austin • a o� or C'Mittor of m owner or operator of <br /> tSzation whoo to I b e or i i e for an axe pTU� ora en <br /> assurance, <br /> -fitle 22' CCR section G/450.13(0) mption fiu[u l�erator operating pnrsuan[ to <br /> assurance, please See Instruction Y are not a grant of <br /> ua for this section. certain as [o whether You qualify for re4�r+emen[s pnisnaat to I <br /> D[ �etnpHon fP�tn rinst,cie! <br /> t k1 <br /> THIN 2: =le=es;gsc )uEUIIC[IOA LOL lIIt'14cHt�ttt <br /> assurance, Please are unstnuuon for Atte section' <br /> please check the appropriate boz: <br /> I As 2 TM Owner or operator or FI'[)owner or operator, I have not operated more than thirty days in a <br /> calendar year. underting <br /> Note: iif bog (I) is marked, your�"to�t(�nditional Amust be utthhorization are not eligih er orlthis rexemption.h <br /> exemption. Generators OP <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 (uTst` 1��<<e.na»• n elg� <br /> the owner or operator certification below. <br /> Tam not required to provide a mechanism- Specufy whr: <br /> Note: If box (3) is marked, Please sign the owner or operator certtticatton below and attach your self- <br /> Note: <br /> certification letter to this rorm. <br /> OWNER OR OPERATOR CERTIFICATION: <br /> •I certify under penalty of law that this document and all ied personentsnel <br /> were prepared Properly <br /> gat er an evaluate duce[`°° in supervision <br /> Ons who manage the system, or those directly responsible for <br /> in accordance with a system designed[o assure that qualified personnel Properly gather surd evaluate the information <br /> submitted. Based on my inquiry of the person or Pers knowledge and belief, true, accurate and complete. I <br /> gathering the infortmtion, the itifomtatiou is, to the but g my informthe possibility of fines and <br /> am aware that there are significant penalties for submitting fake information, including <br /> imprisonment for knowing violations." <br /> 1 • <br /> NAME (PRINT OR TYPE) TITLE <br /> f <br /> SIGNATURE SIGNED <br /> 11 raGE 3 OF 3 <br /> d CSC 1232(8196) Formerly 6113(1196) <br /> i <br />