My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
BILLING
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
S
>
SONORA
>
239
>
2300 - Underground Storage Tank Program
>
PR0501295
>
BILLING
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
1/2/2021 10:11:48 PM
Creation date
11/6/2018 2:01:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
RECORD_ID
PR0501295
PE
2381
FACILITY_ID
FA0005056
FACILITY_NAME
DELTA WELDING PRODUCTS INC
STREET_NUMBER
239
Direction
W
STREET_NAME
SONORA
STREET_TYPE
ST
City
STOCKTON
Zip
95203
CURRENT_STATUS
02
SITE_LOCATION
239 W SONORA ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\S\SONORA\239\PR0501295\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
10/23/2017 6:29:40 PM
QuestysRecordID
3694621
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
4
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
( <br /> STATE OF CALIFOR O <br /> WATER RESOURCES CONTOL BOARD <br /> A <br /> FORM `A': <br /> UNDERGROUND STORAGE TANK PROGRAM �o <br /> SITE y FACILITY/SITE, INFORMATION and/or PERMIT APPLICATION : I o <br /> COMPLETE THIS FORM FOR EACH FACILITY/SITE <br /> MARK ONLY ❑ 1 NEW PERMIT ❑ 3 RENEWAL PERMIT ❑ 5 CHANGE OF INFORMATION 0-7PERMANENTLY CLOSE ITE I"A <br /> ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY SITE CLOSURE <br /> 00 <br /> I. FACILITY/SITE INFORMATION &ADDRESS - (MUST BE COMPLETED) <br /> FACILI ITE NA E CARE OF ADDRESS INFORMATION <br /> a c <br /> ADDRES NEAREST CROSS STREET ✓Aorta udiak ❑ PARTNERSHIP ❑ STATE AGENCY <br /> c _ B-TT0W0RATI0N ❑ LOCALAGENCY ❑ FEDEWAGENCY I^rlljl iW, <br /> ❑ INDIVIDUAL ❑ MUM AGENCY <br /> CITY NAMEStulA <br /> STATE ZIP DE_ � I` SITEPHO WITH E o <br /> F-1F-] LI,\VItrIN,V <br /> TYPE OF BUSINESS: 2 DISTRIBUTOR 4 PROCESSOR ✓Boz it INDIAN EPA ID ft �QJlr�J1l� )\ <br /> RESERVATION or X of TANK's <br /> E] 1 GASSTATION [:] 3 FARM ❑.69TRER TRUST LANDS ❑ ATTHISSITE I <br /> EMERGENCY CONTACT PERSON(PRIMARY) EMERGENCY CONTACT PERSON(SECONDARY) <br /> DAYS: NAME(LAST,FIRST) PHONE It WITH AREA CODE DAYS'. NAME(LAST,FIRST) PHONE a WITH AREA CODE <br /> NIGHTS: NAME LAST.FIRST) PHONE WITH AREA CODE NIGHTS: NAME(IAST,FIRST) PHONE a WITH AREA CODE <br /> II. PROPERTY OWNER INFORMATION &ADDRESS - (MUST BE COMPLETED) <br /> NAME CARE OF ADDRESS INFORMATION <br /> yw-R <br /> MAILING or STREET ADDRESS ✓Box to Indicate ❑ PARTNERSHIP ❑ STATE-AGENCY <br /> ❑ CORPORATION ❑ LOCAL-AGENCY ❑ FEDERAL-AGENCY <br /> ❑ INDIVIDUAL ❑ COUNTY-AGENCY <br /> CITY NAME STATE ZIP CODE PHONE#,WITH AREA CODE <br /> III. TANK OWNER INFORMATION & ADDRESS - (MUST BE COMPLETED) <br /> NAME CARE OF ADDRESS INFORMATION <br /> MAILING or STREET ADDRESS ✓Box to indicate ❑ PARTNERSHIP ❑ STATE-AGENCY <br /> ❑ CORPORATION ❑ LOCAL-AGENCY ❑ FEDERALAGENCY <br /> ❑ INDIVIDUAL ❑ COUNTYAGENCY <br /> CITY NAME STATE ZIP CODE PHONE a,WITH AREA CODE <br /> IV. LEGAL NOTIFICATION AND BILLING ADDRESS <br /> CHECK ONE(1)BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR BOTH LEGAL NOTIFICATION AND BILLING: I. 11. ❑ III. ❑ <br /> THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY,AND TO THE BEST OF MY KNOWLEDGE,IS TRUE AND CORRECT <br /> APPLICANT'S NAME(PRINTED 8 SIGNATURE) DATE <br /> LOCAL AGENCY USE ONLY <br /> COUNTY# JURISDICTION At AGENCY# FACILITY ID# #of TANKS at SITE <br /> Ell I N 011 = 1016161 11 <br /> CURRENT LOC GENCY FACILITY APPROVED BY NAME PHONE#WITH AREA CODE <br /> PERMIT NUMBER L III PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> LOCATION CODE CENSUS TRACT SUPERVI50 ID RICT CODE BUSINESSPUNFILED <br /> NO ❑ DATE ( 3 I' � �� <br /> CHECK# 1 PERMIT AMOUNT SURCHAA—R1lGE AMOUNT FEE CODE RECEIPT# CCLB.YLI <br /> THIS FORM MUST BE ACCOMPANIED BY AT LEAST#R MORE TANK PERMIT FORM 'B'APPLICATION(S), UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. �1 <br /> FORM A(3-2-88) J <br /> DATA PROCESSING COPY <br />
The URL can be used to link to this page
Your browser does not support the video tag.