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BILLING_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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26975
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2300 - Underground Storage Tank Program
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PR0232512
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BILLING_PRE 2019
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Entry Properties
Last modified
1/20/2022 3:31:05 PM
Creation date
11/5/2018 4:23:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0232512
PE
2381
FACILITY_ID
FA0003645
FACILITY_NAME
CARPENTER, GAE & EDWARD
STREET_NUMBER
26975
Direction
S
STREET_NAME
LAMMERS
STREET_TYPE
RD
City
TRACY
Zip
95376
APN
20924019
CURRENT_STATUS
02
SITE_LOCATION
26975 S LAMMERS RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\L\LAMMERS\26975\PR0232512\BILLING 1991-1992.PDF
QuestysFileName
BILLING 1991-1992
QuestysRecordDate
8/4/2017 6:21:45 PM
QuestysRecordID
3554476
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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STATE OF CALIFORNIA WATER RESOURCES CONTROL BOARD <br /> FORM A: UNDERGROUND STORAGE TANK PROGRAM 0 Z <br /> SITE / FACILITY/SITE, INFORMATION and/or PERMIT APPLICATION '_;I,A Ic <br /> (/ COMPLETE THIS FORM FOR EACH F ILITY/SITE <br /> 00 <br /> MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT 5 CHANGE OF INFORMATION ❑ 7 PERMANENT <br /> 2 INTERIM PERMIT 4 AMENDED PERMIT CL SITE I"'a <br /> ONE ITEM ❑ ❑ ❑ 6 TEMPORARY SITE CLOSURE U <br /> I. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) tV <br /> W <br /> FACILITY/SITE NAM / CARE OF ADDRESS INFORMATION <br /> ADDRESS J/ //�,� I•/^pv�_IA �/A NEAREST CROSS STREET ON <br /> 0 CO� 1e Cl PARTNERSHIP El 37ATE 014 ❑ LOCAL AGENCY Cl FiDEML-AEGDO <br /> q -7S/ /y Aa "' / Y/ ❑ INONI011AL ❑ COLO AGENCY <br /> SITE PHONE N,WITH AREA CODE <br /> CIN NAME STATE ZIP CODE <br /> CA 761 <br /> TYPE OF BUSINESS: ❑2 DISTRIBUTOR ❑ 4 PROCESSOR ✓Box if INDIA EPA 10 N M Of TANIP# <br /> ESE <br /> ❑ I OASSTATION ❑ 3 FARM ❑ 5 OTHER TRUSTVATION LANDS ❑ AT THIS SITE <br /> EMERGENCY CONTACT PERSON(PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) <br /> DAYS' NAME(LAST,FIRST) PHONE N WITH AREA CODE DAYS: NAME(LAST.FIRST) PHONE N WITH AREA CODE <br /> NIGHTS: NAME(LAST,FIRST) PHONE N WITH AREA CODE NIGHTS: NAME(LAST,FIRST) PHONE N WITH AREA CODE <br /> II. PROPERTY OWNER INFORMATION & ADDRESS- (MUST BE COMPLETED) <br /> NAME CARE OF ADDRESS INFORMATION <br /> MAILING or STREET ADDRESS ✓Box to indicate 0 PARTNERSHIP 0 STATE-AGENCY <br /> 0 CORPORATION 0 LOCAL-AGENCY Cl FEDERAL-AGENCY <br /> 0 INDIVIDUAL 0 COUNTY-AGENCY <br /> CITY NAME STATE ZIP CODE PHONE N,WITH AREA CODE <br /> III. TANK OWNER INFORMATION & ADDRESS - (MUST BE COMPLETED) <br /> NAME CARE OF ADDRESS INFORMATION <br /> MAILING or STREET ADDRESS ✓Bax to Indicate 0 PARTNERSHIP 0 STATE-AGENCY <br /> 0 CORPORATION 0 LOCAL-AGENCY 0 FEDERAL-AGENCY <br /> 0 INDIVIDUAL Cl COUNTY-AGENCY <br /> CIN NAME STATE ZIP CODE PHONE it,WITH AREA CODE <br /> IV. LEGAL NOTIFICATION AND BILLING ADDRESS <br /> CHECK ONE(1)BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR BOTH LEGAL NOTIFICATION AND BILLING: 1. ❑ it. ❑ III. ❑ <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT. <br /> APPLICANT'S NAME(PRINTED&SIGNATURE) DATE - <br /> LOCAL AGENCY USE ONLY <br /> COUNTY M JURISDICTION# AGENCY k FACILITY IDM #of TANKS of SITE <br /> CURRENT LOCAL AGENCY F CILITY ID N APPROVED BY NAME PHONE It WITH AREA CODE <br /> PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> LOCATION CODE CENSUS TRACT SUPERVISOR-DISTRI -SrOOE BUSINESS PLAN FILED DATE FILED <br /> !� a YES NO <br /> CHECK# PERMITAMOUNT SURCHARGE AMOUNT FEE CODE RECEIPT# BY: <br /> THIS FORM MUST BE ACCOMPANIED BY AT LEAST(1)OR MORE TANK PERMIT FORM `B'APPLICATION(S), UNLESS THIS IS A CHANGE OF SITE INFORMATIIO14 ONLY. <br /> FORM A(3-2.88) 0 <br /> DATA PROCESSING COPY • V <br />
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