Cal. Code Regs. Tit. 18, div. 2, ch. 1.5, art. 1, exh. B - Statement of Underground Storage Tank Operator

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

Notes

Cal. Code Regs. Tit. 18, div. 2, ch. 1.5, art. 1, exh. B