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EM-IVI <br /> California Environmental Reporting System (CERS) Underground Storage Tank-Facility Inform7atio <br /> acility/Site <br /> AVE ON GAS& LIQUOR CERS ID <br /> 20 W YOSEMITE AVE 10180727 <br /> MANTECA,CA 95337 <br /> Submittal Status <br /> Submitted on 1/13/2015 by pritpol Singh of SAVE ON GAS&LIQUOR(MANTECA,CA) <br /> ype of Action <br /> New Permit <br /> Facility Information Tank Operator <br /> AVE ON GAS&LIQUOR Pritpal Singh <br /> 20 W YOSEMITE AVE 209)237-4700 <br /> MANTECA,CA 95337 420 W.Yosemite Ave. <br /> acility type Board of Equalization Account Number Manteca,CA 95337 <br /> Motor Vehicle Fueling 44050861 <br /> s the facility located on Indian Reservation/Trust lands? <br /> D <br /> Property Owner rank Owner <br /> Pritpal Singh ritpal Singh <br /> 510)734-4111 510)734-4111 <br /> 20 W YOSEMITE AVE 120 W YOSEMITE AVE <br /> MANTECA,CA 95337 AANTECA,CA 95337 <br /> ank Owner Type <br /> Nan-Government <br /> emit Holder Information <br /> ermit Holder Notification Information Supervisor of Division,Section,or Office(Required for Public Agencies Only) <br /> acility Owner <br /> Financial Responsibility Mechanism(s) <br /> indicate which approved mechanism(s)are being used to show financial responsibility either as contained in the federal regulations(40 CFR,Part 280,Subpart H,Sections 280.93 through <br /> 80.107)or CCR,Title 23,Division 3,Chapter 18,Section 2808.1. <br /> Self-Insured Surety Bond State Fund and CFO Letter Other Mechanism <br /> Yes <br /> Guarantee Letter of Credit State Fund and CO <br /> Insurance Exemption Local Government Mechanism <br /> pplicant Certification <br /> pplicant Name Applicant Title Applicant Phone Date Certified <br /> Pritpal Singh owner (510)734-4111 1/13/2015 <br /> Printed on 1/13/2015 2:11 PM <br />