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5/28/2014 'IST Program:Facility Information Permit Applicatlon:Cl—S Busin� <br /> 1s/ tea/ ` `` � <br /> '�l -Ji ( <br /> California Environmental Reporting System:Business Kulwinder Johai's Acmum Sion Ou[ Toots $gQgytf Hep <br /> Home Submittals Facilities Compliance My Business <br /> UST Facility Operating Permit Application: JIMCO TRUCK PLAZA' FA'qD0 0jsa <br /> Home U Prepare Submittal(101806371 D UST:UST Facility Operating Permit Application(Draft) <br /> ppQi Instruc*Wisblelp <br /> 1lal Dkrard Edit Cancel <br /> O <br /> New Permit <br /> nkOpemtor - <br /> JIMCOTRUCK PLAZA! Tank Operator Name Phone <br /> 1022 E FRONTAGE RD Kulwinder Johal 209-456-7474 <br /> RIPON , CA 95366 Mailing Address <br /> Facility Type 1022 FRONTAGE RD <br /> Motor Vehicle Fueling City State ZIP/Postal Code Country <br /> BOENumber RIPON CA 95366 United States <br /> 44002495 <br /> Is the facility located on Indian Peservation/rruat Iands4 --Tank Own. <br /> No <br /> Pinar Name Phone <br /> Owne, <br /> OLYMPIAN JV (650)596-8950 <br /> Mailing Address <br /> Owner Name Phone 1300 INDUSTRIAL RD <br /> OLYMPIAN JV 650-596-8950 City State ZIP/Postal Code Country <br /> Mailing Address SAN CARLOS CA 94070 United States <br /> 1300 INDUSTRIAL RD Tank Owner Type <br /> City State ZIP/Postal Code Country Non-Government <br /> SAN CARLOS CA 94070 United States <br /> RTan <br /> mitHolder hitttineaion Information Supervisor of Division,Section,or Office(Required for Public Agencies Only) <br /> k Operator <br /> Inancief Responsibility-Mechanisms <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 K <br /> Sections 280.93 through 280.107)or CCR Title 23,Division 3,Chapter 18,Section 2808.1. <br /> Self-Insured Surety Bond State Fund and CFO Letter Other Mechanism <br /> No No Yes No <br /> Guarantee Letter of Credit State Fund and CD <br /> No No No <br /> Insurance Exemption Local Government Mechanism <br /> No No Nin <br /> ® Q CERS Help + Settings My Business <br /> kpplicaM-eerl}8ca' <br /> I certify that the information provided in this UST submittal is accurate and current,and that this facility complies with all applicable Underground Storage <br /> Tank requirements. <br /> Applicant Name Applicant Title Applicant Phone Date Certified <br /> Ruth Ali Representative 209-535-1511 51162014 <br /> Created By:Syaem Admini9 toron 9/24/2012 6:11 AM <br /> Ian Upda%d W.Kulwinder Johal on 5/16/2014 2:48 PM Edit Cancel <br /> Version 2.22.01671 Enhancements;I CERS Central Diagnostics I Conditions of Use I R'wacy Policy I Contact I Help <br /> California Environmental Reporting System Business 10 2014 California Environmental Protection Agency <br /> CERS Technical Support:Reauest Technical Assistance <br /> Drilled Progrartmeneral Assistance:Contact your local reoulawrel <br /> ht4s://cwsbusiness2.calepa.ca.goV49409/FacilitVIO180637/SubrrittdIDraf/UST1155947/Fwilitylnfwniafion/Detail/511349 1/2 <br />