аЯрЁБс>ўџ @Bўџџџ?џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС №ПНbjbjрр .:‚j‚j џџџџџџl<<<<<<<PР Р Р Р д lP2L L L L L L L L ?AAAAAA$F f xei<L L L L L e, <<L L Ю, , , L "<L <L ?, L ?, Ђ, ЮVŸ@<<cL @ pYs ЮФPpР n Ъп cмф0ыxо 8 єо c, PP<<<<йState Water Resources Control Board Division of Financial Assistance P.O. Box 944212 Sacramento, CA 94244-2120Grants for Upgrading Underground Storage Tank APPLICATION This application provides required information to apply for an underground storage tank installation grant through the RUST Program, as authorized in Chapter 6.76 (commencing with section 25299.100) of Division 20 of the Health and Safety Code. Complete and submit this application with all required documentation to the above address.APPLICANT INFORMATIONThis application is being filed by: q№ UST Owner q№ UST Operator q№ UST Owner & OperatorApplicant/Business NameFed Tax ID/SSN:*How Many Employees?Project Address:City State Zip CodeMailing Address:City State Zip CodeContact PersonTelephone No.Cell No.Fax No.Applicant Status (Check One)q№ Individualq№ Sole Proprietorq№ Partnershipq№ Corporationq№ Estate/Trustq№Other Please answer the following: Is this business independently owned and operated? q№ YES q№ NO Is this business dominant statewide in its field of operation? q№ YES q№ NO Has the applicant/relative owned all USTs listed since January 1, 1997? q№ YES q№ NO Has the project facility where the tank(s) is located sold, at retail q№ YES q№ NO less than 900,000 gallons of gasoline annually for last 2 years? Is there an attached list of other USTs located in California that are q№ YES q№ NO owned and operated by the Applicant? Please attach the following: Copy of Applicant’s most recent employee tax form (IRS Form 941 or California EDD Form DE 6). Copy of Applicant’s most recent California Tax Return. Copy of Schedule G, Fuel Seller’s Supplement To Sales And Use Tax Return Forms, SBE Form 401, submitted by the Applicant to the State Board of Equalization during the last eight quarters. Copy of current tank operating permit for each Project Tank, issued after January 1, 1999. ESTIMATE OF COSTS (Only cost to comply with H&S Code sections 25284.1, 25292.4 and 25292.5 are eligible for funding)Estimated Eligible Costs to Complete Work: (Attach copies of Quote/Bid/Contract)$VERIFICATION AND SIGNATUREAs the undersigned applicant(s) to the Grants for Upgrading Underground Storage Tanks Program, I (we) hereby certify, under penalty of perjury, under the laws of the State of California, that the information provided in this Application is true and correct and represents the intended use of all sources of funds identified in the Application, and that I will inform the State Water Resources Control Board immediately of any changes therein. Executed on this day of 20 Signature Printed Name Title Signature Printed Name Title Optional Information for Government Monitoring Purposes Race/National Origin q№ American Indian q№ Asian/Pacific Islander q№ African American/Black not Hispanic q№ Hispanic q№ White; not Hispanic q№ Other (specify) * Pursuant to the Federal Privacy Act of 1974, you are hereby notified that it is mandatory to provide a Federal Tax Identification number or Social Security number. This number will be used by the State solely for the purpose of identifying the recipient of the Grant Funds. Rev. 11/18/04 pqruvwЅБВГ46~€šœМОьюhjцшdfТФў   < > X Z t v ’ ”   Ђ Є І Ј т ф P R ` b ю № ў œ ž Ќ Ў F H V X v x † ˆ о р КЛМ1§љ§љѕюышхс§л§д§д§д§л§л§л§л§л§д§д§д§д§д§д§лЯ§Ь§Ь§Х§Х§Х§Х§Х§Х§Х§Х§Х§Х§Ь§Ь§Ь§ CJOJQJCJOJQJ CJOJQJ 5CJ\ *CJCJCJCJ 56\]6]5\CJN$EUpqrstuvљљљљ№ъhљљb$If$$If–l4ж”АжF”џЈ Єœ*` џџџџџџџџџџџџџџџџ`ќџџџџџџџџџџџџџџџџј џџџџџџџџџџџџџџџџж0џџџџџџі6ж џџџџџџџџџџџџж џџџџџџџџџџџџж џџџџџџџџџџџџж џџџџџџџџџџџџ4ж laі$If $$Ifa$$If НўvwЅБВ}№wqk$If$If$If$$If–l4ж”@жF”џЈ Єœ*  џџџџџџџџџџџџџџџџ ќџџџџџџџџџџџџџџџџј џџџџџџџџџџџџџџџџж0џџџџџџі6ж џџџџџџџџџџџџж џџџџџџџџџџџџж џџџџџџџџџџџџж џџџџџџџџџџџџ4ж laіВГ4ЃDA\;$If[$$If–l4ж”фж”џœ*+џџџџџџџџџџџџж0џџџџџџі6жџџџџжџџџџжџжџџџџ4ж laі$If[$$If–l4ж”фж”џœ*+џџџџџџџџџџџџџџџџж0џџџџџџі6жџџџџжџџџџжџџџџжџџџџ4ж laі46ью@hšp”8ј”””[$$If–l4ж”hж”џœ*+ж0џџџџџџі6жџжџжџжџ4ж laі$Ifd$$If–l4ж”фж”џœ*+ жж џѓѓѓж0џџџџџџі6жџжџжџжџ4ж laіhjŒ–Рц}ќwwww$If$$If–l4ж”hжF”џ4Єœ* pј ж0џџџџџџі6ж џџџж џџџж џџџж џџџ4ж laіцш >df„ ВТjќddddjМdddd$If”$$If–l4ж”hж\”џр4Єœ*LTџџџџpџџџџџџџџј џџџџж0џџџџџџі6жџџџџжџџџџџџџџџџжџџџџжџџџџџџџџџџ4ж laі ТФцў < X t ’   jМdddddddd$If”$$If–l4ж”hж\”џV Єœ*Т Т Œ ј ж0џџџџџџі6жџџџџжџџџџжџџџџжџџџџ4ж laі   Ђ Є 1+$IfЭ$$If–l4ж”hжž”џTє ќPЄј%œ*Рџџџџ џџџџџџџџџџџџџџџџTџџџџџџџџTџџџџџџџџTџџџџџџџџЄџџџџж0џџџџџџі6жџџџџџџџжџџџџџџџџџџџџџџџџџџџџџџџџџжџџџџџџџжџџџџџџџџџџџџџџџџџџџџџџџџџ4ж laіЄ І Ј т ф l И b ц ’ о р lœЄ–––ŒŒŒŒ–Œ––––‚ & F$If & F$If$Ifb$$If–l4жж”џœ*+ жж џѓѓѓж0џџџџџџі6жџжџжџжџ4ж laіlЃ_КЛМ1ѕѕѕыи‰$If[$$If–l4ж”ж”џœ*+ж0џџџџџџі6жџжџжџжџ4ж laі „8$If^„8 & F$If12ƒ…†šP””%pn$$If–l4ж”hж0”џX œ*Ф D ж0џџџџџџі6жџџжџџжџџжџџ4ж laі$Ifd$$If–l4ж”фж”џœ*+ жж џѓѓѓж0џџџџџџі6жџжџжџжџ4ж laі12…†ЁЂ]^pt|‚…ˆŠ•žŸ­ЕНТУФЯийчяїќ§ў&(\^ЎАШЪјњ&(*ЎЏМНњїњїєї№ї№ї№эї№щї№ї№щэї№щї№ї№єїффффффтолилеCJCJ CJ>*CJ>*OJQJ>*CJCJ>*CJCJ CJ 5CJ\4†ЁЂ]^ˆ‰ŠžŸТУФийќ§љ–p ŠŠŠŠŠŠŠŠŠŠŠŠŠ$If$Ifb$$If–l4жж”џœ*+ жж џѓѓѓж0џџџџџџі6жџжџжџжџ4ж laі$If§ў6LЊ&(*+ЎЏНЅ”ŸŸŸŸŸЅ$IfY$$If–l4жж”џœ*+ж0џџџџџџі6жџжџжџжџ4ж laі ,1h/R Аа/ Ар=!Аа"Аа#А$А%ААА i8@ёџ8 NormalCJ_HaJmH sH tH 6@6 Heading 1$@& 6CJ]<@< Heading 2$$@&a$ 5CJ\<@< Heading 3$$@&a$ 6CJ]6@6 Heading 4$@& 5CJ\<< Heading 5$$@&a$ 5CJ\<A@ђџЁ< Default Paragraph Font*B@ђ* Body TextCJFCF Body Text Indent „а^„а 6CJ] :џџџџ$EUpqrstuvwЅБВГvw ДЕЦЫрѓє 23BPYabsŒžЌКЩабвгдёђ6…м1sЩя№ lЃ_КЛМ12ƒ…†ЁЂ] ˆ ‰ Š ž Ÿ Т У Ф и й ќ § ў 6 т у y ќ § Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€™0€€Љ0€€Љ0€€Љ0€€™0€€Љ0€€Љ0€€Љ0€€™0€€Љ0€€™0€€Љ0€€™0€€Љ@0€€™@0€€Љ0€€Љ0€€Љ0€€™0€€Љ0€€Љ0€€Љ0€€Љ0€€™0€€Љ@0€€Љ@0€€Љ0€€Љ0€€™@0€€Љ@0€€Љ@0€€Љ@0€€Љ@0€€™@0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€™0€€Љ0€€™0€€Љ0€€Љ0€€Љ0€€Љ 0€€Љ 0€€Љ 0€€Љ 0€€Љ@0€€Љ 0€€Љ@0€€Љ@0€€Љ0€€Љ0€€Љ 0€€Љ 0€€Љ 0€€Љ 0€€Ћ@0€€™@0€€Љ0€€™0€€Љ0€€Љ0€€™0€€Љ0€€™0€€Љ0€€Ћ0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€Љ0€€Ћ0€€™0€€Љ0€€Ћ0€€™0€€˜0€€˜0€€˜0€€˜0€€1Н vВ4hцТ  Є l1†§ННЊЎ–š ?EvŸ (.GOw}…Юд#)26ЛСЪЯяL N Y Ѕ А с 333333333333yzЄЄГww ДЕЕЫкръ )ббККЭ0] ^ ќ ќ ў у ќ §     џџkgardnerMC:\Documents and Settings\kgardner\My Documents\ab 1068 grant application.dockgardner<J:\RUST Forms\New Applications\ab 1068 grant application.dockgardner<J:\RUST Forms\New Applications\ab 1068 grant application.dockvaline<J:\RUST Forms\New Applications\ab 1068 grant application.dockgardner<J:\RUST Forms\New Applications\ab 1068 grant application.dockgardner<J:\RUST Forms\New Applications\ab 1068 grant application.dockgardner<J:\RUST Forms\New Applications\ab 1068 grant application.dockgardner>J:\RUST Forms\New Applications\ab 1068 grant application 1.dockgardner<J:\RUST Forms\New Applications\ab 1068 grant application.dockgardner<J:\RUST Forms\New Applications\ab 1068 grant application.doc)7k0ђјф-џџџџџџџџџгpНNк|А<џџџџџџџџџИu№OLрB‹џџџџџџџџџ„а„˜ўЦа^„а`„˜ўo(.€„ „˜ўЦ ^„ `„˜ў.‚„p„LџЦp^„p`„Lџ.€„@ „˜ўЦ@ ^„@ `„˜ў.€„„˜ўЦ^„`„˜ў.‚„р„LџЦр^„р`„Lџ.€„А„˜ўЦА^„А`„˜ў.€„€„˜ўЦ€^„€`„˜ў.‚„P„LџЦP^„P`„Lџ.а„8„˜ўЦ8^„8`„˜ўB*OJQJo(phџЗ№а „ „˜ўЦ ^„ `„˜ўOJQJo(oа „p„˜ўЦp^„p`„˜ўOJQJo(Ї№а „@ „˜ўЦ@ ^„@ `„˜ўOJQJo(З№а „„˜ўЦ^„`„˜ўOJQJo(oа „р„˜ўЦр^„р`„˜ўOJQJo(Ї№а „А„˜ўЦА^„А`„˜ўOJQJo(З№а „€„˜ўЦ€^„€`„˜ўOJQJo(oа „P„˜ўЦP^„P`„˜ўOJQJo(Ї№h„а„˜ўЦа^„а`„˜ў.€„ „˜ўЦ ^„ `„˜ў.‚„p„LџЦp^„p`„Lџ.€„@ „˜ўЦ@ ^„@ `„˜ў.€„„˜ўЦ^„`„˜ў.‚„р„LџЦр^„р`„Lџ.€„А„˜ўЦА^„А`„˜ў.€„€„˜ўЦ€^„€`„˜ў.‚„P„LџЦP^„P`„Lџ.Иu№O)7k0гpНNџџџџџџџџџџџџџџџџ         (ЋbБ                 pqrstuvwВГvw ДЕЦЫрѓє 23BPYabŒžЌКЩабвгЛМ12ƒ…†ЁЂ§ ў т у žžžžžžžžžžžžžžžžž–џ@ €ЙЙdN N  @       @  ,@џџUnknownџџџџџџџџџџџџG‡z €џTimes New Roman5€Symbol3& ‡z €џArial;€Wingdings?5 ‡z €џCourier New"qˆ№аhm›‹Іm›‹ІЪВŠІтС Y№аАДД20d4 Щ2ƒQ№џџState of Californiakgardnerschultzcrustўџр…ŸђљOhЋ‘+'Гй0”˜ МШмшє ( D P \ ht|„ŒфState of Californiatat kgardnerCalgargar Normal.dotl schultzctl2huMicrosoft Word 9.0@@ДКjИФ@ЯЮФ@ЯЮФтС ўџеЭеœ.“—+,љЎ0 hp€ˆ˜  ЈАИ Р рфttcaf4  State of California Title ўџџџ !"#$%&'()*+,-.ўџџџ0123456ўџџџ89:;<=>ўџџџ§џџџAўџџџўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџRoot Entryџџџџџџџџ РF`Ѓu ЮФC€1Tableџџџџџџџџџџџџо WordDocumentџџџџџџџџ.:SummaryInformation(џџџџ/DocumentSummaryInformation8џџџџџџџџџџџџ7CompObjџџџџjObjectPoolџџџџџџџџџџџџ`Ѓu ЮФ`Ѓu ЮФџџџџџџџџџџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџ џџџџ РFMicrosoft Word Document MSWordDocWord.Document.8є9Вq