Laserfiche WebLink
sh _ <br /> 4IFIED PROGRAM CONSOLIDATED FO <br /> UNDERGROUND STORAGE V INK w�YI <br /> OPERATING PERMIT Ariz LICATION-FACI.Lri Y INFORMATION , ✓laal <br /> (G (One form per facility) <br /> TYPE OF ACTION ❑ L NEW PERMIT ❑ 5.CHANGE OF INFORMATION ® 7.PERMANENT FACILITY CLOSURE 90. <br /> (Check one item only) ❑ 3.RENEWAL PERMIT <br /> ❑ 6.TEMPORARY FACILITY CLOSURE ❑ 9.TRANSFER PERMIT <br /> I. FACILITY INFORMATION <br /> TOTAL NUMBER OF USTs AT FACILITY 460. FACILITY IDN <br /> 2 A en Use On C.J CG O <br /> BUSINESS NAME(S.u FACILITY NAME.DBA-Doing%..As) 3. <br /> Reynolds Podesta LLC <br /> BUSINESS SITE ADDRESS 10 CITY ton. <br /> 14175 E. Itighway 26 Linden <br /> FACILITY TYPE ❑ 1.MOTOR VEHICLE FUELING ❑ 2.FUEL DISTRIBUTION 403- Is the facility,located on Indian Reservation or 405. <br /> ❑ 3.FARM ❑ 4.PROCESSOR ® 6.OTHER Trust lands? ❑Yes ®No <br /> H. PROPERTY OWNER INFORMATION <br /> PROPERTY OWNER NAME 407. PHONE 408. <br /> Reynolds Podesta LLC 209 369-2725 <br /> MAILING ADDRESS 409. <br /> 33 E.Tokay St. <br /> CITY Oto. 1 STATE 411, 1 Z[PCODE 412. <br /> Lodi CA 95240 <br /> III. TANK OPERATOR INFORMATION <br /> TANK OPERATOR NAME 428-1. 1 PHONE 428-2 <br /> Re olds Podesta LLC (209) 369-2725 <br /> MAILING ADDRESS 4za.3 <br /> 33 E.Tokay St. <br /> CITY 428-4 1 STATE 4N-5 ZIP CODE 42M <br /> Lodi CA 95240 <br /> IV. TANK OWNER INFORMATION <br /> TANK OWNER NAME 414. 1 PHONE 415. <br /> Reynolds Podesta LLC (209)369-2725 <br /> MAILING ADDRESS 416. <br /> 33 E.Tokay St. <br /> CITY 417. 1 STATE 419. ZIP CODE 419. <br /> Lodi CA 95240 <br /> OWNER TYPE: ❑ 4.LOCAL AGENCY/DISTRICT ❑ 5.COUNTY AGENCY ❑ 6.STATE AGENCY 4zo. <br /> ❑ 7.FEDERAL AGENCY ® &NON-GOVERNMENT <br /> V. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> TY(TK)HQ 44- Call the Stake Board of Equalizatioq Fuel Tax Divisioq ifthere are questions. 421. <br /> VI.PERMIT HOLDER INFORMATION <br /> Issue permit and send legal notifications and mailings to: ® 1.FACILITY OWNER ❑ 4.TANK OPERATOR 423 <br /> ❑ 3.TANK OWNER ❑ S.FACILITY OPERATOR <br /> SUPERVISOR OF DIVISION,SECTION,OR OFFICE(Required For Public Agencies Only) 406. <br /> VII.APPLICANT SIGNATURE <br /> CERTIFICATION: I certifV that the information provided herein is true,accurate,and in full compliance with I al requirements. <br /> APPLI T SIGNA DATE4N. <br /> PHONE 4zs <br /> M- 4 '0 (209)369-2725 <br /> APPLICANT N (print) 426. APPLICANT TITLE 427 <br /> Reynolds Po sta LLC by Craig Lusk Manager <br /> UPCF UST-A Rev.(122007) <br />