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�tNIFIED PROGRAM CONSOLIDATED FORA PR#:PRO231511 FAC#:FA00036" UNDERGROUND STORAGE TANKS -FACILI S'V ItoLl V9 (one page per site) 01, YJ J TYPE OF ACTION E] L NEW SITE PERMIT 3.RENEWAL PERMIT ❑ S.CHANGE OF INFORMATION ❑ 7.PERMANENTLY CLOSED SITE r- (Check one item only) 4.AMENDED PERMIT ❑ 8.TANK REMOVED ❑6.TEMPORARY SITE CLOSURE 400 I.FACILITY/SITE INFORMATION 7611 S AIRPORT WAY.STOCKTON BUSINESS NAME Page m FAcar1V NAME a DBA-Doing Baines Ar) 3 FACILITY ID# PR ION G I TRUCKING CO CORP FA0003695 PR0231511 NEAREST CROSS STREET FACILITY OWNER TYPE ❑ 4.LOCAL AGENCY/DISTRICT• ❑ I CORPORATION AIRPORT WAY 401 ❑ S.COUNTY AGENCY" BUSINESS ❑ LGAS STATION ❑ 3.FARM N 5.COMMERCIAL ❑ 2.INDIVIDUAL ❑ 6.STATE AGENCY- TYPE ❑ 2.DISTRIBUTOR ❑ 4.PROCESSOR ❑ 6.OTHER 403 ❑ 3.PARTNERSHIP ❑ 402 ].FEDERAL AGENCY• TOTAL NUMBER OF TANKS Is facility on Indian Reservation or "Ifowner of UST is a public agency:name of supervisor ofdivision,section or office which operates REMAINING AT SITE trustlands? the UST(This is the contact person for the tank records.) 404 ❑ Yes N No 405 CONSOLIDATED FREIGHTWAYS aO6 IL PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407 PHONE 408 G I TRUCKING CO CORP 714 523-1122 MAILING OR STREET ADDRESS 409 2767 E IMPERIAL HWY STE 200 CITY 410 STATE 411 ZIPCODE 412 BREA I CA 92821 PROPERTY OWNER TYPE ® I.CORPORATION ❑ 2.INDIVIDUAL ❑ 4.LOCAL AGENCY/DISTRICT ❑ 6.STATE AGENCY ❑3.PARTNERSHIP ❑ 5.COUNTY AGENCY ❑ 7.FEDERAL AGENCY 413 111.TANK OWNER INFORMATION TANK OWNER NAME 414 PHONE 415 G I TRUCKING CO CORP 360 4484275 MAILING OR STREET ADDRESS 416 2767 E IMPERIAL HWY STE 200 CITY 417 STATE418 ZIPCODE 419 BREA CA 92821 TANK OWNER TYPE Q 1.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- 44-011765 1 Call(916)322-9669 if questions arise a21 V.PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(s) I] 1.SELF-INSURED ❑4.SURETY BOND ❑ 7.STATE FUND ❑ 10.LOCAL GOVT MECHANISM ❑2.GUARANTEE ❑5.LETTER OF CREDIT O 8.STATE FUND&CFO LETTER ❑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 angling will be sent to the tank owner unless box 1 or 2 is checked. VII.APPLICANT SIGNATURE Certification-1 certify that the information provided herein is nue and accurate to the best ofmy knowledge. SIGNATURE OF APPLICANT DATE 424 1 PHONE 425 NAME OF APPLICANT(print) 426 TITLE OF APPLICANT 427 STATE UST FACILITY FIUMBER(Far loaf m my) 428 1998 UPGRADE CERTIFICATE NUMBER(Fa loal au my) 429 Is 1998 Compliant?Y UPCF(1/99 revised)