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x— <br /> OWMED PROGRAM CONSOLIDATED F <br /> UNDERGROUND STORAGE'1r-kNK <br /> OPERATING PERMIT"PLICATION-FACI� V 0. <br /> TION 1 <br /> /G- (One forth per facility) <br /> TYPE OF ACTION ❑ 1.NEW PERMIT ❑ 5.CHANGE OF INFORMATION <br /> (Check we item Daly) ❑ 3.RENEWAL PERMIT ❑ 6.TEMPORARY FACB,ffY CLOSURE El 9-TRANSFERPERMANENT <br /> EFFACILITY C URE <br /> V <br /> I. FACILITY INFORMATION �r1 <br /> TOTAL NUMBER OF USTs AT FACILITY 4oa. <br /> 2 FACILITY ID# <br /> ame ae <br /> ROSINESS NAME(SFACB.ITY NAM DBA—Doing Buainevs As) <br /> A en Use On <br /> Reynolds Podesta LLC 3. <br /> BUSINESS SITE ADDRESS <br /> toa. <br /> 14175 E.IIi wa 26 1m. CITY <br /> Linden <br /> FACILITY TYPE ❑ I.MOTOR VEHICLE FUELING [12.FUEL DISTRIBUTION 003' Is the facility located on Indian Reservation or aos. <br /> ❑ 3.FARM ❑ 4.PROCESSOR ® 6.OTHER Trust lauds? ❑Yes ONO <br /> II. PROPERTY OWNER INFORMATION <br /> PROPERTY OWNER NAME anz. PHONE <br /> Reynolds Podesta LLC 408 <br /> MAILING ADDRESS (209 369-2725 <br /> 409. <br /> 33 E.To St. <br /> CITY <br /> vo. STATE Ott. ZIP CODE alz. <br /> Lodi <br /> CA 95240 <br /> III. TANK OPERATOR INFORMATION <br /> TANK OPERATOR NAME 428-1. PHONE <br /> 426 2 <br /> Reynolds Podesta LLC (209)369-2725 <br /> MAILING ADDRESS <br /> 33 E.Toka St, 428.3 <br /> CITY <br /> 028'4 STATE 4�5 ZIP CODE 42a.6 <br /> Ludt CA 95240 <br /> TANK OWNER NAME IV. TANK OWNER INFORMATION <br /> 414. PHONE 415. <br /> Re olds Podesta LLC (209)369-2725 <br /> MAILING ADDRESS <br /> 33 E.To St. 416, <br /> CITY <br /> Lodi 417. STATE 418. ZIP CODE 419. <br /> CA95240 <br /> OWNER TYPE: ❑ 4.LOCAL AGENCY/DISTRICT ❑ 5.COUNTY AGENCY ❑ 6.STATE AGENCY ago. <br /> ❑ 7.FEDERAL AGENCY ® &NON-GOVERNMENT <br /> V. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> TY(TK)HQ 44 Call the State Board of Equalization,Fuel Tax Division,if there are questions. 42L <br /> VI.PERMIT HOLDER INFORMATION <br /> Issue permit and send legal notifications and mailings to: ® 1.FACILITY OWNER El4.TANK OPERATOR 423 <br /> ❑ 3.TANK OWNER El 5-FACILITY OPERATOR <br /> SUPERVISOR OF DIVISION,SECTION,OR OFFICE(Required For Public Agencies Only) aob. <br /> VII.APPLICANT SIGNATURE <br /> CERT ATION: I ce that t e information rovided herein is true,accurate,and io full cum liance with I al r uirements. <br /> APPLi SIGNA DA 4z4 PHONE 425. <br /> APPLICANTN (print) 4u. / _0 (209 369-2725 <br /> Re olds Po sta LLC b Crai Lusk APPLlcANT TITLE 42, <br /> Mana er <br /> UPCF UST-A Rev.(122007) <br />