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California Environmental <br /> Reporting <br /> FWYOSEMWTE <br /> AS&LIQUOR CERS ID <br /> AVE 10180727 <br /> 95337 <br /> ubmittal Status <br /> ubmitted on 1/13/2015 by pritpal singh of SAVE ON GAS&LIQUOR(MANTECA,CA) <br /> ype of Action <br /> New Permit <br /> acility Information ank Operator <br /> AVE ON GAS&LIQUOR ritpal Singh <br /> 20 W YOSEMITE AVE 209)237-4700 <br /> ANTECA,CA 95337 20 W.Yosemite Ave. <br /> CAF <br /> Type Board of Equalization Account Number anteca,CA 95337 <br /> otor Vehicle Fueling 44050861 <br /> s the facility located on Indian Reservation/Trust lands? <br /> 0 <br /> roperty Owner rank Owner <br /> ritpal Singh Iritpal Singh <br /> 510)734-4111 510)734-4111 <br /> 20 W YOSEMITE AVE 20 W YOSEMITE AVE <br /> MANTECA,CA 95337 MANTECA,CA 95337 <br /> rank Owner Type <br /> on-Government <br /> ermit 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 CD <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 />