California Code of Regulations
Title 23 - Waters
Division 3 - State Water Resources Control Board and Regional Water Quality Control Boards
Chapter 18 - Petroleum Underground Storage Tank Cleanup Fund Regulations
Article 4 - The Fund
Section 2811.2 - Fund Application Requirements; Reimbursement Requests for Corrective Action Costs

(a) the name of the claimant, a correspondence address, a telephone number or numbers where the claimant can be contacted during normal business hours, and a federal tax identification number or social security number;

(b) if a joint claim is submitted by multiple owners and operators, the name, correspondence address, telephone number or numbers, tax identification number or social security number of each claimant, and the dates during which each claimant owned or operated the underground storage tank or residential tank that is the subject of the claim;

(c) if the claimant designates a representative to be a co-payee for payment from the Fund, the name, address, and telephone number of the co-payee;

(d) the site address or a description of the site where the underground storage tank or residential tank that is the subject of the claim is located, and a site map drawn to scale which includes a north arrow and distances relative to the nearest public roads;

(e) any identification number assigned by a regulatory agency, and the underground storage tank storage fee account number assigned by the California Board of Equalization, if applicable;

(f) a brief description of the background of the claim, to the best of the claimant's knowledge, including the following:

(g) a statement of the priority class sought by the claimant and the following documentation to support assignment to that priority class:

(h) a statement of the total amount of costs for which reimbursement is sought;

(i) a certification that all corrective action costs claimed were incurred for work performed after January 1, 1988;

(j) a certification that the claimant meets all applicable eligibility requirements set forth in section 2811 of this chapter;

(k) an agreement by the claimant that the Board may conduct an audit of any claim honored by the Board and that the claimant will reimburse the Board for any disallowance of costs occasioned by such an audit. The claimant must agree to retain all records pertaining to the claim for a period of at least three years after final payment by the Fund, and to provide the records to the Board upon request. The three-year period shall be extended until the completion of any audit in progress; and

(l) a copy of any agreement entered into by a claimant where a person agrees to incur costs on behalf of the claimant or where the claimant assigns Fund reimbursement rights to a person;

(m) if a claimant has entered into the agreement described in subdivision (l), documentation that confirms the date of the agreement (e.g., a sworn statement by all parties to the agreement);

(n) any other information or supporting documentation reasonably required by the Division to determine the eligibility, reimbursable amount due, or appropriate priority class of the claim.