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CITY OF ANAHEIM CUPA FIRE DEPARTMENT / HAZARDOUS MATERIALS SECTION 201 S. ANAHEIM BOULEVARD, SUITE 300, ANAHEIM, CA 92805 PHONE: (714) 765-4040 FAX: (714) 765-4608 UNDERGROUND STORAGE TANK OWNER/OPERATOR AGREEMENT REVISED 07/2008 BUSINESS NAME (Same as FACILITY NAME or DBA – Doing Business As) 2 BUSINESS PHONE 102 BUSINESS SITE ADDRESS 103 CITY ANAHEIM 104 CA ZIP CODE 105 As the owner of the underground storage tank(s), I hereby certify that I have provided the operator a copy of the requirements contained in California Code of Regulations, Title 23, Division 3, Chapter 16. I also certify that I have provided the operator with a copy of the penalties for noncompliance as specified in Section 25299, Chapter 6.7, California Health and Safety Code. TANK OWNER NAME (Please Print) DATE TANK OWNER SIGNATURE As the operator of the underground storage tank(s), I hereby certify that I understand the requirements contained in California Code of Regulations, Title 23, Division 3, Chapter 16, and I have received a copy of Section 25299, Chapter 6.7, California Health and Safety Code. TANK OPERATOR NAME (Please Print) DATE TANK OPERATOR SIGNATURE