California Code of Regulations
Title 23 - Waters
Division 3 - State Water Resources Control Board and Regional Water Quality Control Boards
Chapter 16 - Underground Tank Regulations
Appendix XI - Underground Storage Tank Designated UST Operator Identification Form
Universal Citation: 23 CA Code of Regs XI
Current through Register 2024 Notice Reg. No. 38, September 20, 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
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.
Disclaimer: These regulations may not be the most recent version. California may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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