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UNIFIED PROGRAM CONSOLIDATED FO FA Fnc a; I U'2� �"� PR a; 0231E48 (i 000zosz UNDERGROiUND STORAGE TANKS - FAl�tO 1 6)0-1 (one page per site) TYPE OF ACTION ❑ I NEW SrrE PERMIT ❑3 RENEWAL PERMIT5 C14ANGI 01;INPORNIAFION ❑7 PERMANENTLY CLOSEDSIThM. (Check one ncm only) ❑4.ANIE•NDED PERMIT X x ifychaab�local h4Conly -:.[ ❑ 8.'rANK RL'MOVED ❑ 6.-rr.mPORARY Sl 11 CLUSURF 4W I.FACILITY/SITE INFORMATION 3505 NAVY DR,STOCKTON 13USINESS NAME(SaorcasFACILITYNAME orDUA•Doing llamwssAS) FACILITYID11 PRIDII ST SERVICES FA0002052 PR0231948 NEAREST CROSS STR1 1-f FACILITY OWNER'I'YP6 ❑4.LOCAL AGENCY/DISTRICT'- 401 ® I CORPORATION=% �� ❑S.COUNTY AGENCY• I3USINESS ❑ 1 GAS S'I'A'I'ION ❑3.FARM ❑5.COMMERCIAL. ❑2.INDIVIDUAL ❑6.STATE AGENCY" TYPL, ❑2.DISTRIBUTOR ❑4.PROCESSOR ❑6 OTHER 403 ❑3 PARTNERSHIP ❑ 7.FEDERAL AGENCY- of TOTAL NUMBER 01:TANKS Is facility on Indian Reservation or •Irowner ofUST is a public agency:name of sulmivisor ofdivision,section or office which operates REMAINING AT SITE Irtisllands? the US'r(This is the comacl person for the tank records.) 404 ❑ Yes ® No 405 4% 11.PROPERTY OWNER INFORMATION PROI'I It rY OWNRR.NAME -- aur I'HONL 4011 A R. R,L• A 407 A . L _ CITY ,tu S'fAPE ,11 LIP COX 412 PROPER OWNER TYPE ® )•CORPORATION ❑ 2.INDIVIDUAL ❑4.LOCAL AGENCY/DISTRICT ❑6.S'rATAGENCY 03.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.ITDERAL AGENCY •113 111.TANK OWNER INFORMATION TANK OWNER NAME 414 PHONE 413 ST SERVICES 209 943-5662 MAILING OR STREET ADDRESS 416 2941 NAVY DR CITY ,12 STATE 418 %IPCODE 419 STOCKTON CA 195206 TANK OWNER TYPE © I,CORPORATION ❑2.INDIVIDUAL 114.LOCAL AGENCY/DISTRICT 116.STATE AGENCY 420 ❑3.PARTNERSHIP ❑5.COUMfY AGENCY ❑7.FEDERAL AGENCY IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER. I TY('CK)HQ 44- 44-000400 1 Call(916)322-9669 if questions arise i21 V.PETROLEUM UST FINANCIAL RESPONSIBILITY INDICA TE METHOD(s) © I.SELF-1NSURL.D ❑4.SURETY BOND ❑ 7.STATE I:UND ❑ 10.LOCAL GOVT MECHANISM ❑2.GUARANTEE ❑5.I.E fTER OF CREDIT ❑ 8.STATE FUND&CFO LETTER ❑99.0'I'HER 113.INSURANCE ❑6.EXEMP-1.10N ❑ 9.STATE FUND&CD 422 Vl. LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and nmibng ® I.FACILITY ❑2.PROPERTY OWNER ❑3.•TANK OWNER '123 Legal notifications and mailing will be sent to the tank owner unless box I or 2 is checked. V11.APPLICANT SIGNATURE Cendicati -1 ecnify that the information provided herein is true and accurate to the best of niy knowledge. SIGNA 11E OF APPLICANT' DATE. 424 PHONE 421 E APPLICAN (print) '1'I 1 AI'I'I ICnNT �� �� S'1'ATLAS"fPACILT(YNUM[3ERporucaiucoml zk le 4:z L L!A. z 434 1998UI'GItADECL'RT'IFICATENUMI3! t(roriocaitueonn) 29 Is 1998 Compliam?Y IIPCI-'(1/99 revised)