Cal. Code Regs. Tit. 18, div. 2, ch. 1.5, art. 1, exh. B
Exhibit B
STATEMENT OF UNDERGROUND STORAGE TANK OPERATOR
(Title 18, California Code of Regulations, Section 1213)
Account No.: TK MT 44-______________________________
| ___________________________ | ||
| Location of tanks(s) STREET | CITY | COUNTY |
| ___________________________ | ||
| Name of Tank Owner | Area Code and Telephone Number | |
| ___________________________ | ||
| Mailing Address of Tank Owner |
By executing this document, I/we understand that all returns and notices regarding the above Underground Storage Tank Maintenance Fee Account will be mailed to me/us, as the tank operator identified below. As the operator of the underground storage tank, I/we acknowledge I/we am/are paying the Underground Storage Tank Maintenance Fee on behalf of the tank owner and will not apply for a refund of the fees on the basis that I/we am/are not the owner of the tank and, therefore, do not owe the fees. I/we will notify both the Board of Equalization and the tank owner of any changes affecting this account. I also acknowledge receipt of a copy of the Board's Publication 88, Underground Storage Tank Fee.
| ___________________________ | ___________________________ | ||
| Name of Tank Operator (Please Print) | Area Code and Telephone Number | ||
| ___________________________ | |||
| Mailing Address of Tank Operator | |||
| ___________________________ | ___________________________ | ||
| Signature of Tank Operator | Date | ||
| ___________________________ | |||
| Title (owner, partner, corporate officer) | |||
| ___________________________ | ___________________________ | ||
| Signature of Tank Operator | Date | ||
| ___________________________ | |||
| Title (owner, partner, corporate officer) | |||
| Attach Notary Statement Here |
Cal. Code Regs. Tit. 18, div. 2, ch. 1.5, art. 1, exh. B