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California Environmental Reporting System (CERS) Underground Storage Tank- Facility Information <br /> utility/Site <br /> IPacific Avenue Chevron CERS ID <br /> X6633 Pacific Avenue 10594654 <br /> l tockton,CA 95207 <br /> � <br /> ubmittal Status <br /> ubmitted on 10/20/2014 by Jenn Bartlett of Edward R.Marszai Enterprises,Inc.(Carmichael,CA) <br /> ubmittal was Accepted;Processed on 10/21/2014 by NG,WILLY for San Joaquin County Environmental Health <br /> ZType of Action <br /> ransfer Permit <br /> Racility Information --- ---- --- _--- ank Operator- --- _ —_--_ <br /> Pacific Avenue Chevron Edward R.Marszel Enterprises,Inc. <br /> 633 Pacific Avenue 916)488-3666 <br /> tockton,CA 95207 .O.Box 1096 <br /> acility Type Board of Equalization Account Number armichael,CA 95609 <br /> uel Distribution 44044722 <br /> s the facility located on Indian Resemadon/Trust lands? <br /> 0 <br /> roperty Owner rarmichael, <br /> er <br /> merican Petroleum,LLC etroleum,LLC <br /> 916)488-3666 666 <br /> .0.Box 1096 96 <br /> armichael,CA 95609 ,CA 95609 <br /> Typement <br /> �Permit HolderInformation - <br /> Permit Holder Notification Informabon Supervisor of Division,Section,or Office(Required for Public Agencies Only) <br /> [Tank Operator <br /> financial Responsibility Mechanism(s) <br /> Indicate which approved mechanisms)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 /> 280.107)or CCR,Title 23,Division 3,Chapter 18,Secben 2808,1. <br /> Lelf-,Ind Surety Bond State Fund and CFO Letter Other Mechanism <br /> Yes <br /> LetterofCredit State Fund and CO <br /> Exemption Local Government Mechanism <br /> ylp icant Name <br /> ppiicant Name Applicant Title applicant Phone Dace Certified <br /> enn Bartlett Director of Finance (916)488-3666 10/20/2014 <br /> Printed on 10/21/2014 11:48 AM <br />