Laserfiche WebLink
A .1 <br /> IED PROGRAM CONSOLIDATED FO �ti �` Q <br /> TANKS <br /> ROUND STORAGE TANKS- FACILITYN ISI <br /> UNDERG (One page per site) Page of <br /> TY;O�FION ❑1.NEW PERMIT ❑3.RENEWAL PERMIT ❑5.CHANGE OF INFORMATION Z 7.PERMANENTLY CLOSED SITE490(Chonly) ❑4.AMENDED PERMIT (Specify change) <br /> ®8.TANK REMOVED <br /> ❑6.TEMPORARY SITE CLOSURE <br /> I. FACELITY/SITE INFORMATION <br /> BUSINESS NAME(S..pACILITYNAMEor DBA-Doing Business As) a. FACILITY 1. <br /> Hondo Com an LLC ID#/,F <br /> NEAREST CROSS STREET (,A 4m. FACILITY OWNER TYPE ❑4.LOCAL AGENCY/DISTRICT* aoz. <br /> ❑ 1.CORPORATION ❑5.COUNTY AGENCY* <br /> Curry Avenue <br /> 403. 2.INDIVIDUAL ❑6.STATE AGENCY <br /> BUSINESS ❑ 1.GAS STATION Z 3.FARM ❑5.COMMERCIAL ❑ 7.FEDERAL AGENCY* <br /> TYPE ❑2.DISTRIBUTOR ❑4.PROCESSOR [16.OTHER ❑3.PARTNERSHIP ❑ p 406. <br /> 404 IS facile on Indian Reservation 405. r If owner of UST is a a he agency: name of su pe of division,section or <br /> TOTAL NUMBER OF TANKS ty office which operates the UST. (This is the contact person for the tank records.) <br /> REMAINING AT SITE or trust lands? <br /> 0 ❑Yes Z No <br /> II. PROPERTY OWNER INFORMATION <br /> aoz PHONE 40& <br /> PROPERTY OWNER NAME 209-369-8255 <br /> Hondo Com anLLC 409. <br /> MAILING OR STREET ADDRESS <br /> PO Box 1 410, STATE <br /> 411. ZIP CODE a12. <br /> CITY 95258 <br /> Woodbrid e CA 413. <br /> PROPERTY OWNER TYPE ❑ I.CORPORATION ❑2.INDIVIDUAL ❑4.LOCAL AGENCY I DISTRICT ❑6.STATE AGENCY <br /> [13.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.FEDERAL AGENCY <br /> III.TANK OWNER INFORMATION <br /> 414. PHONE 415, <br /> TANK OWNER NAME 209-369-8255 <br /> Hondo Cont any LLC 416. <br /> MAILING OR STREET ADDRESS <br /> PO Box 1007419. <br /> 4n, STATE 419. ZIP CODE <br /> CITY 95258 <br /> Woodbridge CA <br /> TANK OWNER TYPE ❑ 1,CORPORATION [12.INDIVIDUAL ❑4.LOCAL AGENCY/DISTRICT ❑6.STATE AGENCY ago. <br /> ❑3.PARTNERSHIP ❑5.COUNTY AGENCY [17.FEDERAL AGENCY <br /> IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> TY TK) Q 44- <br /> Call(916)322-9669 if uestionS arise 421, <br /> H <br /> V.PETROLEUM UST FINANCIAL RESPONSIBILITY <br /> INDICATE METHOD(s) ❑ .SELF-INSURED ❑4.SURETY BOND ❑7.STATE FUND <br /> 1110,10.LOCAL GOVTMECHANISM 422. <br /> El22.GUARANTEE ❑5.LEITER OF CREDIT ❑S.STATE FUND&CFO LETTER ❑99.OTHER: <br /> ❑3.INSURANCE [16.EXEMPTION ❑9.STATE FUND&CD <br /> VL LEGAL NOTIFICATION AND MAILING ADDRESS <br /> Check one box to indicate which address should be used for legal notifications and mailing. 413. <br /> Legal notifications and mailings will be sent to the tank owner unless box I or 2 is checked. [1 L FACILITY ®2. PROPERTY OWNER ❑3.TANK OWNER <br /> VII.APPLICANT SIGNATURE <br /> Certification: 1 certify that the information provided herein is true and accurate to the best of my knowledge. a24 PHONE 425' <br /> SIGNATURE LI DATE //Q � 3 /p- 1 y 1 <br /> / O / ?S J 427. <br /> NAMEANT(print) 426. TITLE OF APPLICANT <br /> 13.b Leve <br /> STATE UST FACILITY NUMBER(Agency use only) <br /> 429 1 1999UPGRADE CERTIFICATE NUMBER(Agency use only) 429. <br /> (See Data Element 1,above. <br /> Rev.02/16/00 <br /> UPCF Hwfwrc-a(1/99)-1/2 <br /> www.unidors.org <br />