Laserfiche WebLink
03/09/04 TUE 13:11 FAX 714 428 8087 TOSCO MARKETING COMPANY 0 007 <br /> �FIED PROGRAM CONSOLIDATEO�&M <br /> L 7 TANKS <br /> UNDERGROUND STORAGE TANKS - FACILITY <br /> (one page Per site) <br /> TYPE OF ACTION ❑t NEW SfTEPERMIT Pape _ at _ <br /> (Chace 0ne Nam only) ❑s.RENEWAL PERMIT I&5.CHANGE OF INFORMATION rSDeetly Menge• ❑7,PERMANENTLY CLOSED SITE <br /> ❑4.AMENDED PERMIT lowl usa 0My) E.TANK REMOVED 400 <br /> ❑B.TEMPORARY SITE CLOSURE <br /> I.FACILITY!srrE INFORMATION <br /> BUSINESS NAME(Sana an FACILITY NAME Or DBA-D01np B0vne:i As) 3 FAGLITV IO# <br /> Circle K Stores Inc.#2705449 <br /> BUSINESS SITE ADDRESS 401 IEUH <br /> IFpAICILITY OWNER TYPE <br /> 7647 PACIFIC AVE g 1, CORPORA71ON 4. LOCALAGENGYIDISRaCT- <br /> IrL9_J'{I2� INDIVIDUAL 5. COUNTY AGENCY' <br /> 13USINFSS TYRE i,GAS STATION ❑ 3.FARM ❑E,COMmeitrA 3. PARTNERSHIP e. STATE AGENCY• <br /> L DISTRIBUTOR [] 4.PROCESSOR ❑ S,OTHER LLL L FEDERAL AGENCY' 402 <br /> 403 <br /> TOTALNUMEER OF WS Is facoly pn Indian Rs,0Mtlw or Townes aUSTISe pery <br /> REMAINING AT SITE Irustlende7 dlvkbn eeeWn or Omcellwnl�h operator @io U97. Isor of <br /> ��-Il qqIl ITAIe ii the weed person for Ik GN(h dd d,. <br /> 3 404 U Yes Ky N04M 408 ) <br /> 11.PROPERTY OWNER INFORMATION <br /> PROPERTY OWNER NAME 4p7 <br /> BEST CALIFORNIA GAS LTD PHONE 408 <br /> MAILRIG OR STREETAOORESS 40p <br /> (510)245-6219 <br /> 13116 IMPERIAL HWY <br /> CITY 410 <br /> SANTA FE SPRINGS STATE 411 IPCODE 12 <br /> CA 90670 <br /> PROPERTY OWNER TYPE 2. INDIVIDUAL ff'-�5 <br /> EI 1. CORPORATION g 4. LOGLAGENCY/DISTRIOT ❑3 8. STATEAGENCY 413 <br /> . PARTNERSHIP 5.COUNTYAGENCY ❑ 7. FEDERAL AGENCY <br /> rANK owNFR NAME 414 III•TANK OWNEWINFORMARION;: <br /> _. ..... , <br /> Circle K Stores Inc. PHONE 416(909)270-5193 <br /> MAILING OR 87REET AOpRE$g 416 <br /> 495 East Rincon Ste 150 <br /> ITr 417 <br /> Corona STATE 418 OCE 9 <br /> CA 92879 <br /> TANK OWNER TYPE 2. INDIVIDUAL® 4. LOCAL AGENCY/DISTRICT 1. ;oRPORATION 8. STATEAGENCY 42p <br /> 3. PARTNERSHIP 6. COUNTY AGENCY 7. FEDERALAGENCY <br /> III Fey A, <br /> TY . 4, 4 3 2 1 0 7 3 Call(916)322-86691 <br /> CIK)HA <br /> f questions arise <br /> 421 <br /> jix <br /> :'INDIOATF'MSTHOD(S) '❑ I. SELF-INSURED . . ❑ 4. 511RETY BOND" - - '7. STATE'RUND' `: ❑ i8 LOCALGOV.TMECHANNIM'.. . <br /> ❑ 2. GUARANTEE 5. LETTER OF CREDIT El 8. STATE FUND&CFO LETTER El Ga.OTHER: <br /> ® & INSURANCE ❑ 9. EXEMPTION ❑ a STATE FUND&CDWA <br /> 422 <br /> nOf Oca1lo401MIwle Marten eddreae ahwle EG eted 1011Bgll n011flCetlOnB and rralllriIl----�IRR��a <br /> Ba n4 bid Inshn awiB De Sew la the lank 0vner unless 6or<1 or 2le cneeked, rJ 1. FADIurV ❑ 2; PROPERTY OWNER 3.YANK OWNER <br /> CeNSgllOn; 1 oapfy Ina1 the h#ormellon provided herein is eye and emur4le lP the beat a nY Knowledge, <br /> SIGNATURE OF APP DA 424 PHONE <br /> -. <br /> 425 <br /> NAME OF APPLICANT y <br /> {909)270 5193 <br /> TITLE 428 <br /> Michelle Wilson West Coast Environmental Compliance Manager <br /> STATE UST FAGLITV NUMaER(Fpr(p0al use Dory) 427 1998 UPGRADE CERTFICgTE NUMeER(yrMceI use Only) US <br /> UPCF(1199 revised) 5 Formerly SWRCS Form A <br />