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California Environmental Reporting System (CERS) Underground Storage Tank- Facility Information <br /> 1111110 <br /> rEHarney <br /> e <br /> CERANE AMPM 10 ID <br /> 10484500 <br /> Ln <br /> , 40 <br /> ubmittal Status <br /> ubmitted on 7/24/2014 by KEN DHARNI of HARNEV LANE AMPM(Lodi,CA) <br /> ype of Action <br /> onfirmed/Updated Information <br /> acuity Information EHARNEYLANE <br /> ARNEY LANE AMPM C <br /> 55 E Harney Ln <br /> odi,CA 95240 ANEacilityType Board of Equalization Account Number <br /> Motor Vehicle Fueling 44049954 <br /> s the facility located on Indian Resemabon/Trust lands? <br /> 0 <br /> roperty Owner ETypo <br /> er <br /> HARNI LADA LLC A LLC <br /> 209)339-2371 371 <br /> 55 E HARNEV LANE EV LANE <br /> ODI,CA 95240 240 <br /> ypement <br /> ermit Holder Information <br /> ermit Holder Notification Information Supervisor of Division,Section,or Office(Required for Public Agencies Only) <br /> acility Owner <br /> inancial Responsibility Mechanisms) <br /> ndicate which approved mechanism($)are being used to show financial responsibilitV either as Contained in the federal regulations(40 CFR,Part 280,Subpart H,Sections 280.93 through <br /> 80.107)or CCR,Title 23,Division 3,Chapter 18,Section 2808.1. <br /> elf-insured Surety Bond State Fund and CFO Letter Other Mechanism <br /> Yes <br /> uarantee Letter of Credit State Fund and CD <br /> nsumnce Exemption Local Government Mechanism <br /> pplicant Certification <br /> pplicant Name Applicant Title Applicant Phone Date Certified <br /> EN DHARNI PRESIDENT (906)715-6425 3/3/2014 <br /> Printed on 7/24/2014 10:42 AM <br />