Laserfiche WebLink
ROM OCAMPO-ESTA FAX NO. : 5526047 Sep. 20 2004 02:48PM P2 <br /> UNIFMW PROGRAM CONSOLIDA'17D FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - FACILITY <br /> (One page persitc) Page I of3 <br /> TYPE OF ACTION ❑L New PERMIT ❑3.RPNRWAL PERMIT Q S.CTIANOE OF AIPORMn1TON <br /> (Cheek now item•.IY) ❑4.AMGNDED PERMIT (apmdy Tunas) l&e,IANIC RSP-ldO VED NTLY �SNU SITE 4M0 6.TEMPORARY SITE CLOSURE .. <br /> I. F:A�ITYS IaPR'A�M,Q'x4,1'IY)]kl' t <br /> _.. . .. <br /> BUS SNAMEIZ.rerFACILITY NwM6er O9A-Doirm nwkav Ar) 3. FA ILITY <br /> SBC SKTNCAI2 UE132 ' t <br /> NEAR.$ST CROSS STREET 491, PACILI I r OWNER TYPE 114.LOCAL AG Y/DIS . <br /> FOPPIANO LANE ® 1,CORPORATION ❑5.COUNTY AGENCY- <br /> BUSINESS ❑1.GAS STATION El 3.FARM S.COMML7tC7A1, s"'- ❑2.INDNIDUAL Cl 6.STATE AGENCY' <br /> TYPE ❑2.DISTRIBUTOR ❑4.PROCESSOR ®6.OTHER ❑3.PARTNERSHIP ❑7.FEDERAL AGENCY• <br /> TOTAL NUMBER O TANKS 4w. )a lwilhy on Indian Reservation sOZ �lr ewaer of 115f la a plane kaawrc mvnv of tuperruor n d vhien. cecdmr er 406 <br /> REhdAIP(ING AT SITE to treat landa7 o Iles w a h.Penta IIx vsT. Crhis u ere o.nmet pbraan Svr the bank rswrds,) <br /> O I ❑Yes ®NO <br /> ' '� � II ERA>'�i;f�'�t1,°WNER'IIIt�fIA'IgAN <br /> PROI PERTV 0 R NAM> �D PHONb r <br /> sM. <br /> SBC M132) SKTNCAIZ 800-757-6575 <br /> ORS AD S - -"' <br /> 7644 N.ASHLEY LANE <br /> Cf1Y n10 STATE su. ZIP CODE 413, <br /> STOCKTON CA 95212 <br /> TPRO FERTY0WNERTYPE ® CORPORATION -C-2-IN 131VIDUAL I.J 4.LDCALAGBNCV/DISTRICT 6.3TATEAOENCY Ota. <br /> ❑3.PARTNwN P ❑5.COUNTY AGONCY 0 T PEDERALAOENCY <br /> Imo[T <br /> ANKOWNERNAMB - :.. .... :...: .::. .. <br /> SBC ENVIROMFNTAL MANAGEMENT soo-7sT-6s7s <br /> MAILING OR STREET ADDRESS <br /> �O BROOM 3E000 <br /> (�Tv - nz STATE ua. CODE 419. <br /> SAN RAMON CA 194583-0995 <br /> TANK OWNER TYPE (.CORPORATION 2.ItriDIVIDUAL 4.LOCAL AGENC'YbISTRIC"'1` 6.STATE Af - pe <br /> ❑3.PARTNERSHIP ❑5,COUNTY AGENCY ❑7.PFD13R.AL AGENCY <br /> IV! BA'IT ON'UST b`Im-"G$:FzE AICICCAT3N f 74TJAjB[:R <br /> T'Y HQ 44- 3 1 9 7 4T I CRIT I 322-9669 if eatint18 R3iac <br /> .. . *ar .. <br /> INDTCATE METHOD(,) ®1.SMY-TNMMD O 4-SUPM BOND ❑7.STATE FUND ❑10.I.OGALGOV7 MECHANISM Qy <br /> ❑3.GUARANTEE ❑3.[STM OF CREDIT E3 R STATE FUND&CFO LE)YER ❑99,OTHM: <br /> 0 3.INSURANCE 6.EXEMPTION []9.SPATE FUND A CD <br /> - <br /> 31rakens bsa b ind'wb whkk addmr slquN be qN fnr kwl wd6sednn W ms11k1a. <br /> spl notifications and mailings will be scot w the mnk ounw orders hos 1 or 2 is chscket ❑ 1.FACJLITV ❑2. PROPERTY OWNER 103.TANK OWNBR �. <br /> '<7Ii-X;Ff',Y;�f$i1�1' liP�"lRJYi'L - - <br /> wMiieaaal 1 wrdry Sol Ore inrnrmndon pmvlded has:a is vee and aecmek b I)*bot efrry kr.WI.4ae. <br /> ,IIGNATURE APPLICANT ATE m4. P eu <br /> _ $/02/03 9oa7s7-6s7s <br /> NAME DiwAPPUCANT(print) Z 12 1TTI$OF APPIJ AM <br /> UYDRFW TAYLJDR IRNVIRONNEBWAL N ANAGER <br /> -.;TATE UST FACILITY NUMBER Wwwy e.e.d34 01. 1998 UPGRADE CERTIFICATE NUMBER(AS..y us aWyj <br /> ISM Data Eletnant I.tib n,c <br /> TJPCF Hw(wrra((/99)-V2 hctp;(1www.uni419cr.urg Rcv.02/16/00 <br /> RECEIVED FEB-11-04 15:09 FROM-9168561011 TO-1(LEEWN ROESSELEN PAGE 16 <br /> 09/20/04 MON 13:37 iTX/RX NO 83481 Q002 <br />