Appendix XI Underground Storage Tank Designated UST Operator Identification Form
23 CA ADC Div. 3 Ch. 16 App. XIBarclays Official California Code of Regulations
23 CCR Div. 3 Ch. 16 App. XI
Appendix XI Underground Storage Tank Designated UST Operator Identification Form
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
Credits
History
1. New Appendix XI filed 8-27-2018; operative 10-1-2018 (Register 2018, No. 35).
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.
This database is current through 4/26/24 Register 2024, No. 17.
Cal. Admin. Code tit. 23, Div. 3 Ch. 16 App. XI, 23 CA ADC Div. 3 Ch. 16 App. XI
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