Laserfiche WebLink
M.•,�r 24 2006 2: 42PM 209-577-3553 p. 2 <br /> 02 14/2@06 m:49 2094683433 EHD °AGE 03 3'� I <br /> UNIPIE❑ PROGRAM CONSOLIDATED FORM 1 � ` <br /> UNDERGROUND STORAGE TANKS — FACILITY TANKS . <br /> (One Pop per sifeJ <br /> TYPE OF ACTION [• t,N@WSITF PERMIT <br /> (Cheri pne I(@M anry) r 3.RENEWAL PERMIT r 3,CHANGE OF INFORMATION fSpeci CJlen e. s Pepe eI SITE <br /> �Y p IIIIIIIVVVVVV7,PERMANFNTLYCLOSEOSITE <br /> r s.AMENDED PERMIT 4cea,uee anlyl �9.TANK REMOVEO a0C <br /> r 4.TEMPORARYerre CLOSURE <br /> I.FACILITY J SITE INFORMATION <br /> 6us SNAM ISemaa:rZIL1•fYN.WfiaCF9 -OalnpDl,.n.::nsl 3 4FACILirY <br /> RVIO� _ <br /> N 5T ca SS ST eET owT4ER qry P& <br /> r 1. CORPOrLAT10N r J. LOCAL AGENCYiDISTRICT' <br /> 4VSI ES9 A' I,GA9 STATION1�3F..- r5, COUNTYA�',Lc <br /> SCOMMERCIAL r z INMVIDLIAL <br /> r 2 DISTAIQVT'ORa,?ROCESSOA r 5.OTHER 7. PARTNERSHIP r 6. STATE AG <br /> 400 r T. FEDERAL 4Og <br /> TOTAL NUMBER OF TANKS la leeillty an Inpgn Rede Nal on Cr •II own.. <br /> REMAINING AT SITE ? 11 UST iz a n„piC iDal,ty:rump eupd:msol of <br /> P1Mllanne7 4MltI0n,ae♦ipr,N Otf m rlvpT <br /> 00arale2[he UST. <br /> 4Ly <br /> (THIS,it h.can.,;tOarean for w{ank rbtLloz,) /�, /� <br /> l D 4 r yao Na pas 'D6 <br /> (I, PROPERTY OWNER INFORMATION <br /> RR <br /> 0Wf1ER NAmf a0T <br /> MNON15 OR STAEET AOD SS a(i9 <br /> A q <br /> PROP NTY WNeA TYPEr/j_ INOIVICIUAL r ♦. LOCAL AGE NCYI OISTRIGT r d STATE AGENCY ♦17 <br /> 3 <br /> r t, CORPORAT70N PARTNEASHIP <br /> S. COUNTY AGENCv r 7. FEOER/1L nGENCY <br /> d(.TANK DWNER INFORMATION <br /> TANK 0 R NAME o 1. <br /> PHONE 116 <br /> F <br /> MAIL TREETAgORE 5 416 ^" <br /> CI qtr r ..�6 <br /> 1 A ale PC <br /> TANK O N TYPE i INCIVIOVAL ♦ f..Ar <br /> T 1. CORPORATION �y�Q r . LOCAL AGENCY I DISTRICT r 6. STATF AGENCY 420 <br /> All FARTNEASNIP r 5. COUNTY AGENCY <br /> I� r 7, fEDEMI AGENCY' <br /> TY(TK)I- a 4 Cali(916)322.9669 if questions ONSI) <br /> 421 <br /> NOICATE METN00(SI 1, SELK INSUFlD C z SUAETY SONO <br /> eq&" T, STATE FUND <br /> '�r7Q r 10. LOCAL GOVeT MECHANISM <br /> 2 GUARANTEE r S. LETTER OF CREDIT B. STATE FUND i CFO Lel-rER I. go. OTHER: <br /> r 7 [Nsupmca r 5 EXEMPTION T I, STAT:FUND a CO 422 <br /> tnea on.bolt Ic in4-cm.-ner,a0mea IrmLAd b4 ueao(or legal nal ireallom ane rnoimq. A Kin UA 11 IlUr- f <br /> I tiheaC nc A6n s wid b. Ile lank aw "U..I r �. r 1. FACILITY r 2. PROPEFTY OWNER ` 3, TANIC OWNER 423 <br /> CanfWlia,, t CMdy INOI Q,t r+IpnnaUP1 Olaviaea I,pen;I We end ogVnate t0 Ne Deft dmf kn e'ltledg4, - <br /> SIGNATURE Of APPLICANT DATE 42A PHO E <br /> a25 <br /> NALaE OF av PLICANT fN+'�r AZe TIME 'A PUCANTna <br /> _O ♦2T r <br /> dqe <br /> SYATE JST FACILI Nl/MBER ffNA7Glf ure 4Ny( A24 1044 VPGRADE:ERTIF CaT£NVMBER lPor vi vso oayi g <br />