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LIST Program: Facility Inform W <br /> Permit Application: CERS Regulatle Page I of 2 <br /> California Environmental Reporting System:Regulator vicki mccartney's Account Si-an Out Tools Repgrrs. Help <br /> Submittals Facilities Businesses Regulators Compliance Responders Reports <br /> UST Facility Operating Permit Application: Fast Lane Central Valley <br /> Home )) Submittal Search )) Submittal 7;1 a_2016(100633451 )) UST:UST Facility Operating Permit Application(Accepted) <br /> Submittal Element History <br /> Submitted for CERS ID 10063345 on 711812016 2:59PM by Hardeep Gil!of Fast Lane Centras Valley(Lathrop,CA) <br /> Submittal was Accepted on 7/21/2016 by NG,OfiLLYfor San Joaguln County Environmental Health <br /> Return to Submittal <br /> Type of Actio <br /> Renewal Permit <br /> Facility Information Tank Operato <br /> Fast Lane Central Valley Tank Operator Name Phone <br /> 116 Roth Rd B8G Group,Inc 7074313510 <br /> Lathrop, CA 95330 Mailing Address <br /> r <br /> Facility Type /L, } YL 111 Healdsburg Ave <br /> Motor Vehicle Fueling V t r�' I� City State ZIP/Postal Code Country <br /> BOE Number J Healdsburg CA 95448 United States <br /> 44482753 <br /> Is the facility located on Indian ReservationlTrust lands? Tank Owner <br /> No <br /> Owner Name Phone <br /> Property Owner Fast Lane Central Valley LLC 7074313510 <br /> Mailing Address <br /> Owner Name Phone 111 Healdsburg Ave <br /> Fast Lane Central Valley 7074313510 City State ZIPIPostal Code Country <br /> Mailing Address Healdsburg CA 95448 United States <br /> 111 Healdsburg Ave,Ste C Tank Owner Type <br /> City State ZIPipostal Code Country Non-Government <br /> Healdsburg Ca 95448 United States <br /> Permit Halder Information <br /> Permit Halder Notification Information Supervisor of Division,Section,or Office(Required for Public Agencies Only) <br /> Facility Owner <br /> Financial Responsibility Mechanism(s) <br /> Indicate which approved machanism(s)are being used to show financial responsibility either as contained in the federal regulations(40 CFR,Part 280,Subpart H,Sections <br /> 280.83 through 280.107)or CCR,Title 23,Division 3,Chapter 18,Section 2808.1. <br /> Self-insured Surety Bond State Fund and CFO Letter Other Mechanism <br /> No No Yes No <br /> Guarantee Letter of Credit State Fund and CD <br /> No No No <br /> Insurance Exemption Local Government Mechanism <br /> No No No <br /> Applicant Certification <br /> I certify that the information provided in this UST submittal is accurate and current,and that this facility complies with ail applicable Underground Storage Tank <br /> requirements. <br /> Applicant Name Applicant Title Applicant Phone Date Certified <br /> Hardeep Gill Operations Manager 7074313510 - <br /> created By:Hardeep Gill on 7112/2018 12.52 PM <br /> Last Updated By:Hardeep GIII on 711212010 12:53 PM Return to Submittal <br /> Version 2.23 0012 1 Enhancements I CERS Central Diagnostics I Conditions of Use I Privacy Poh I Contact I Helo <br /> California Environmental Reporting System:Business I�)2016 California Environmental Protection Agency <br /> CERS Technical Support Request Technical Assistance <br /> CERS Help Settings Notifiicatl.ris <br /> https://cersregulator,calepa.ca.govBusiness/3 3354/Facility110063 345/SubmittalIUST/178... 11/17/2016 <br />