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TJRN-08-'98 THU 08:59 ID:TESORO TEL N0:209-464-7066 #629 P08 <br /> }Jcdffarnls hufotaL Em kow"ant Pterood"Amy n/ep of Task 8obmorrs Cooaol <br /> CERTIFICATION OF FINANCIAL ASSURANCE <br /> FOR PERMIT BY RULE AND CONDITIONALLY AUTHORIZED OPERATIONS <br /> (See ACaa4ed laetsuctialu) <br /> FOR OFFICIAL USE ONLY <br /> OM REGIONAL OFFICE <br /> i <br /> For use by owner or operator of transportable treatment unit,owner or operator of fixed treatment unit operating under Permit <br /> 3y Rule, or a generator operating pursuant to a grant of Conditional Authorization. <br /> ❑ Initial Certification ❑ Amended Certification ❑ Annual Certification <br /> Put an asterisk in the kft margin nett to the amended information. <br /> GENERAL INFORMATION <br /> A. TYPE OF OPERATION: <br /> ❑ PBR-FTU ❑ PBR-TTU ❑ CA ❑ OTHER <br /> If operation is a TTU, Insert TTU serial number: _ <br /> B. FACILITY=EPA ID NO: <br /> C. FACILITY/1'M NAME: <br /> I <br /> D. ADDRESS OR LEGAL DESCRIPTION OF FACT LITYPITTU LOCATION: <br /> CITY: CA ZIP CODE: <br /> COUNTY: <br /> E, MAILING ADDRESS: - <br /> CITY: STATE: ZIP CODE: <br /> F. CONTACT PERSON: <br /> LASE NAME F1RSf NAME <br /> TELEPHONE NUMBER <br /> TSC 1232(8/96)Formerly 8113(1/96) PAGE I OF 3 <br />