Cal. Code Regs. Tit. 23, div. 3, ch. 16, app XI
Current through Register 2024 Notice Reg. No. 49, December 6, 2024
| TYPE OF ACTION | [] New UST Installation | [] New/Changed Designated Operator |
1. FACILITY INFORMATION
| CERS ID | Facility Name | |
| ___________________________ | ||
| Facility Address | City | ZIP Code |
| ___________________________ | ||
2. DESIGNATED UST OPERATOR INFORMATION
Print names exactly as shown on the ICC certification.
| Name of Designated UST Operator | ICC Certification |
| ___________________________ | |
| Mailing Address | Phone |
| ___________________________ | |
| Name of Designated UST Operator | ICC Certification |
| ___________________________ | |
| Mailing Address | Phone |
| ___________________________ | |
| Name of Designated UST Operator | ICC Certification |
| ___________________________ | |
| Mailing Address | Phone |
| ___________________________ | |
| Name of Designated UST Operator | ICC Certification |
| ___________________________ | |
| Mailing Address | Phone |
| ___________________________ | |
| Name of Designated UST Operator | ICC Certification |
| ___________________________ | |
| Mailing Address | Phone |
| ___________________________ | |
| Name of Designated UST Operator | ICC Certification |
| ___________________________ | |
| Mailing Address | Phone |
| ___________________________ | |
| Name of Designated UST Operator | ICC Certification |
| ___________________________ | |
| Mailing Address | Phone |
| ___________________________ | |
| Name of Designated UST Operator | ICC Certification |
| ___________________________ | |
| Mailing Address | Phone |
| ___________________________ | |
Additional copies of this page may be attached.
CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council, UST = Underground Storage Tank
Cal. Code Regs. Tit. 23, div. 3, ch. 16, app XI
2. Repealer and new appendix filed 8-27-2020; operative 10-1-2020 (Register 2020, No. 35). Filing deadline specified in Government Code section 11349.3(a) extended 60 days pursuant to Executive Order N-40-20 and an additional 60 days pursuant to Executive Order N-66-20.