Form DTSC1306 "Affidavit in Support of Designation as a Qualified Contaminated Site" - California

What Is Form DTSC1306?

This is a legal form that was released by the California Department of Toxic Substances Control - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2002;
  • The latest edition provided by the California Department of Toxic Substances Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form DTSC1306 by clicking the link below or browse more documents and templates provided by the California Department of Toxic Substances Control.

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Download Form DTSC1306 "Affidavit in Support of Designation as a Qualified Contaminated Site" - California

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State of California – California Protection Agency
Department of Toxic Substances Control
AFFIDAVIT IN SUPPORT OF DESIGNATION AS A
QUALIFIED CONTAMINATED SITE
STATE OF CALIFORNIA
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COUNTY OF______________________
The purpose of this Affidavit is to set forth certain information and documentation to
enable the California Department of Toxic Substances Control (hereinafter "DTSC") to
make a statement pursuant to the Taxpayer Relief Act of 1997 (Public Law 105-34 and
as amended by Public Law 106-554 and 108-311). All terms which are found in this
document which are defined in the Act shall have the same meaning as in the statute.
The undersigned, being first duly sworn, deposes and says as follows:
I.
THIS AFFIDAVIT is executed by the undersigned
on behalf of
located at
2.
The property is an area at or on which there has been a release (or threat of
release) or disposal of (a) a hazardous substance, as defined by sections 101(14)
and 102 of the Comprehensive Environmental Response, Compensation and
Liability Act of 1980, subject to the limitations in section 104(a)(3) or (b) a
petroleum product (as defined in section 4612(a)(3)). Analytical results, or other
evidence of a release or threat of a release are attached.
3.
The property is NOT a site on or proposed for the National Priority List under
CERCLA (a "Superfund" site).
[Note: include the following only if applicable – for costs incurred after August 5, 1997
and prior to December 21, 2000]:
4.
The property is located in one of the following targeted areas:
A. Any population census tract with a poverty rate of not less than 20 percent.
B. A population census tract with a population of less than 2,000 if:
(i)
More than 75 percent of such tract is zoned for commercial or
industrial use, and
(ii)
Such tract is contiguous to 1 or more other population census tracts
which meet the requirement of clause (4.A.) without regard to this
clause.
C. Any empowerment zone or enterprise community (and any supplemental
zone designated on December 21, 1994.
DTSC 1306 (4/02)
Page 1 of 2
State of California – California Protection Agency
Department of Toxic Substances Control
AFFIDAVIT IN SUPPORT OF DESIGNATION AS A
QUALIFIED CONTAMINATED SITE
STATE OF CALIFORNIA
Print
Reset
COUNTY OF______________________
The purpose of this Affidavit is to set forth certain information and documentation to
enable the California Department of Toxic Substances Control (hereinafter "DTSC") to
make a statement pursuant to the Taxpayer Relief Act of 1997 (Public Law 105-34 and
as amended by Public Law 106-554 and 108-311). All terms which are found in this
document which are defined in the Act shall have the same meaning as in the statute.
The undersigned, being first duly sworn, deposes and says as follows:
I.
THIS AFFIDAVIT is executed by the undersigned
on behalf of
located at
2.
The property is an area at or on which there has been a release (or threat of
release) or disposal of (a) a hazardous substance, as defined by sections 101(14)
and 102 of the Comprehensive Environmental Response, Compensation and
Liability Act of 1980, subject to the limitations in section 104(a)(3) or (b) a
petroleum product (as defined in section 4612(a)(3)). Analytical results, or other
evidence of a release or threat of a release are attached.
3.
The property is NOT a site on or proposed for the National Priority List under
CERCLA (a "Superfund" site).
[Note: include the following only if applicable – for costs incurred after August 5, 1997
and prior to December 21, 2000]:
4.
The property is located in one of the following targeted areas:
A. Any population census tract with a poverty rate of not less than 20 percent.
B. A population census tract with a population of less than 2,000 if:
(i)
More than 75 percent of such tract is zoned for commercial or
industrial use, and
(ii)
Such tract is contiguous to 1 or more other population census tracts
which meet the requirement of clause (4.A.) without regard to this
clause.
C. Any empowerment zone or enterprise community (and any supplemental
zone designated on December 21, 1994.
DTSC 1306 (4/02)
Page 1 of 2
State of California – California Protection Agency
Department of Toxic Substances Control
AFFIDAVIT IN SUPPORT OF DESIGNATION AS A
QUALIFIED CONTAMINATED SITE
D. Any site announced before February 1, 1997, as being included as a
Brownfields pilot project of the California Environmental Protection Agency.
I swear under oath that this is a true and complete statement.
_____________________________________
(Signature)
Subscribed and sworn to and before me on this
day of
.
(month/year)
_____________________________________
(Notary Public Signature)
My Commission Expires ________________________
(Date)
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DTSC 1306 (4/02)
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