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UNDERGROUND STORAGE TANK <br /> STATEMENT OF UNDERSTANDING AND COMPLIANCE FORM (Page 1 of 1 ) <br /> Every underground storage tank ( UST) facility must submit a one-time statement indicating that the owner or operator <br /> understands and is in compliance with all applicable UST requirements . A copy of this completed form must be submitted <br /> via either the California Environmental Reporting System (CERS) or an equivalent local Unified Program Agency electronic <br /> reporting portal within 30 days of: 1 ) an installation of a UST; or 2) a change in owner or operator of the UST, as applicable. <br /> [California Code of Regulations , Title 23, Division 3, Chapter 16, Section 2715(a).] <br /> Type of Action <br /> [:1 New Installation Eg Change of Ownership ❑ Change of Operator <br /> In FACILITY INFORMATION <br /> Business Name (Same as Facility Name or DBA-Doing Business As) CERS ID <br /> Aisle 1 1 see attached <br /> Business Site Address City ZIP Code <br /> see attached <br /> II . OWNER / OPERATOR INFORMATION <br /> Relationship to Underground Storage Tank(s) <br /> ❑x Owner [I operator <br /> UST Owner / Operator Name Phone # <br /> RADC Enterprises , Inc . (909) 3944728 <br /> Mailing Address City State ZIP Code <br /> 1450 N . Benson Ave , Suite A Upland CA 91786 <br /> Ill . CERTIFICATION BY OWNER / OPERATOR OF UNDERSTANDING AND COMPLIANCE <br /> I hereby certify that I understand the underground storage tank requirements of Health and Safety Code, Division 20, <br /> Chapter 6 .7, California Code of Regulations ; Title 23, Division 3, Chapter 16 ; and any applicable local underground storage <br /> tank ordinances and that the facility identified above is in compliance with all applicable underground storage tank <br /> requirements . <br /> 7w-ner / operator Signatur Date <br /> � 1 2019 <br /> i <br /> ID = Identification <br />