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�(2,k <br /> ReportingCalifornia Environmental <br /> acuity/Site <br /> LOWER SACRAMENTO CHEVRON' CERS to <br /> 660 LOWER SACRAMENTO RD 101813$1 <br /> TOCKTON,CA 95210 <br /> ubmittal Status <br /> ubmitted on 6/16/2016 by bill Mal of MORADA CHEVRON FAST N EASY#60•(STOCKTON,CA) <br /> Of ACtiOn <br /> New Permit <br /> Facility Information Tank Operator <br /> LOWER SACRAMENTO CHEVRON' muhammad bilal <br /> 660 LOWER SACRAMENTO RD 707)486-8894 <br /> TOCKTON,CA 95230 9660 lower sacrament rd <br /> aciity Type Board of Equalization Account Number Stockton,CA 95210 <br /> Motor Vehicle Fueling 44051737 <br /> s the facility located on Indian Reservation/Trust lands? <br /> O <br /> Property Owner rank Owner <br /> acific income Inc nuhammad bila) <br /> 209)561-8789 707)486-8894 <br /> 626lower Sacramento suite#20 f660 lower sacrament rd <br /> tockton,CA 95210 tockton,CA 95210 <br /> ank Owner Type <br /> Non-Government <br /> ermit Holder Information <br /> ermit Holder Notification Information Supervisor of Division,Section,or Office(Required for Public Agencies Only) <br /> Facility Owner Same as Tank Owner <br /> Financial Responsibility Mechanism(s) <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 H,Sections 280.93 through <br /> 80.107)or CCR,Title 23,Division 3,Chapter 18,Section 2808.1. <br /> Self-insured Surety Bond State Fund and CFO Letter Other Mechanism <br /> Yes <br /> Guarantee Letter of Credit State Fund and CD <br /> Insurance Exemption Local Government Mechanism <br /> plicent Certification <br /> Picard Name Applicant Title Applicant Phone Date Certified <br /> uhammad Bilal Partner (707)486-8894 <br /> Printed on 6/20/2016 4:44 PM <br />