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r FIED PROGRAM CONSOLIDATED FORM PR#:PR0231509 FAC#:FA0003809 UNDERGROUND STORAGE TANKS -FACILITY ror M A87I ��yyy555 (one page per site) 1 TYPE OF ACTION El1.NEW SITE PERMIT 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 7.PERMANENTLY CLOSED SITE (Check one item only) ❑4.AMENDED PERMIT sp«ifydwm}c loalisewily ❑ 8.TANK REMOVED I :/ ❑6.TEMPORARY SI FE CLOSURE Opo I.FACILITY/SITE INFORMATION 4800 S AIRPORT WAY,STOCKTON BUSINESS NAME(S.as FACILITY NAME or DBA-Doing Bmfnus As) 5 FACB.PFY LD# PR ID# 1 A G SPANOS AVIATION DEPT FA0003809 PR0231509 NEAREST CROSS-STREET q01 FACIITY OWNER TYPE ❑ 4.LOCAL AGENCY/DISTRICT' AIRPORT,WAY ❑ 1.CORPORATION ❑ S.COUN'T'Y AGENCY" BUSINESS ❑ 2.INDM'UAL TYPE ❑ 1.GAS STATION ❑ 3.FARM ❑ 5.COMMERCIAL ❑ 3 PARTNERSHIP ❑ 6.STATE AGENCY' , 40z ❑ 2.DISTRIBUTOR ❑ 4.PROCESSOR ❑ 6.OTHER 4p3 [:17.FEDERAL AGENCY TOTALNUMBEROF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency:name of supervisor ofdivision,section or office which operates REMAINING AT SITE � trus[lands? the UST(This is the contact person for the tank records.) <� ❑Yes ® No 405 A G SPANOS CONSTRUCTION C d06 II.PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407 PHONE 403 A. G . Spanos Aviation Dept . 209 982-1550 MAILING OR STREET ADDRESS 409 4800 S AIRPORT WAY CITY 410 STATE411 ZIP CODE 412 STOCKTON CA 95206 PROPERTY OWNER TYPE ® L CORPORATION ❑ 2.INDIVIDUAL ❑4.LOCAL AGENCY/DISTRICT ❑ 6.STATE AGENCY E13.PARTNERSHIP ❑ 5.COUNTY AGENCY ❑ 7.FEDERAL AGENCY 413 III.TANK OWNER INFORMATION TANK OWNER NAME 414PHONE 415 SPANOS A G CONSTRUCTION CO 209 982-1550 MAILING OR STREET ADDRESS alb 4800 S AIRPORT WAY CITY 417 STATE 413 1 ZIP CODE 419 STOCKTON CA 95206 TANK OWNER TYPE ❑X I.CORPORATION ❑ 2.INDIVIDUAL ❑4.LOCAL AGENCY/DISTRICT ❑ 6.STATE AGENCY 420 ❑ 3.PARTNERSHIP ❑ 5.COUNTY AGENCY ❑ 7.FEDERAL AGENCY IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY(TK)HQ 44- 44-024728 Call(916)322-9669 if questions arise 431 V.PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(s) ❑ 1 SELF-INSURED ❑4.SURETY BOND ❑ 7.STATE FUND ❑ 10.LOCAL GOVT MECHANISM ❑2.GUARANTEE ❑5.LETTER OF CREDFF ®(8.STATE EUND&CFO LETTER X❑99.OTHER ❑3.INSURANCE ❑6.EXEMPTION ❑ 9.STATE FUND&CD 422 VI.LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. ® 1.FACILITY ❑2.PROPERTY OWNER ❑3.TANK OWNER 423 Legal notifications and mailing will be sent to the tank owner unless box I or 2 is checked. VII.APPLICANT SIGNATURE Certification-I certify that the infomution pro d herein is true and accurate to the best of my knowledge. GNA ICANT DATE 41 PHONE 425 5-13-03 ( 209 ) 982-1550 NAME OF APPLICANT(print) 4z6 TITI-E OF APPLICANT 427 Maureen Brooks Office Manager STATE UST FACILITY NUMBER(F.hx.l aeoaty) 428 1998 UPGRADE CERTIFICATE NUMBER(Forlocalmeody) 4$9 Is 1998 Compliant?Y UPCF(1/99 revised)