My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
BILLING_PRE 2019
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
M
>
MAIN
>
400
>
2300 - Underground Storage Tank Program
>
PR0231903
>
BILLING_PRE 2019
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
10/31/2024 4:30:48 PM
Creation date
11/7/2018 4:57:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0231903
PE
2381
FACILITY_ID
FA0003569
FACILITY_NAME
Main Street Stockton, LLC
STREET_NUMBER
400
Direction
E
STREET_NAME
MAIN
STREET_TYPE
St
City
Stockton
Zip
95202
APN
14915024
CURRENT_STATUS
02
SITE_LOCATION
400 E Main St
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MAIN\400\PR0231903\BILLING 1987-1999.PDF
QuestysFileName
BILLING 1987-1999
QuestysRecordDate
9/5/2017 7:55:32 PM
QuestysRecordID
3624282
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.
/
16
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
STATE OF CALIFORNO WATER RESOURCES CONTABOARD z` �F. <br /> FORM 'A': s <br /> UNDERGROUND STORAGE TANK PROGRAM ' <br /> SITE FACILITY/SITE, INFORMATION and/or PERMIT APPLICATION z <br /> COMPLETE THIS FORM FOR EACH FA ILITY/SITE <br /> MARK ONLY ❑ 1 NEW PERMIT ❑3 RENEWAL PERMIT 5 CHANGE OF INFORMATION 7 PERMANENTLY CLOSED SITE N <br /> ONE ITEM ❑ 2 INTERIM PERMIT ❑ 4 AMENDED PERMIT ❑ 6 TEMPORARY SITE CLOSURE 5 —4 <br /> w <br /> I. FACILITY/SITE INFORMATION &ADDRESS— (MUST BE COMPLETED) W <br /> FACILITY/SITE NAME CARE OF ADDRESS INFORMATION <br /> ,n <br /> ADDRESS p NEAREST CROSS STREET ✓Rp,bNOW Cl PARTNERSHIP ❑ STATE AGENCY <br /> + tN ❑ CORPORATION 11LXkAGBCY Cl FEDERALAGENCY <br /> CITY NAME ❑ INDNIDUAL 0 COUNTY AGENCY <br /> 5+�1 STATE ZIIC��O SITE PHONE k,WITH AREA CODE <br /> C a nom <br /> TYPE OF BUSINESS 2 DISTRIBUTOR 4 PROCESSOR ✓ <br /> ❑ Box It INDIAN EPA ID p <br /> ❑ I GAS STATION ❑3 FARM ❑ 5OTHER RESERVATION or #of TANK'# O� <br /> TRUST LANDS ❑ 1'LO AT THIS SITE <br /> EMERGENCY CONTACT PERSON(PRIMARY) EMERGENCY CONTACT PERSON(SECONDARY) <br /> DAYS: NAME(LAST,FIRST) PHONE N WITH AREA CODE DAYS: NAME(LAST,FIRST) PHONE k WITH AREA CODE <br /> NIGHTS: NAME(LAST.FIRST) PHONE k WITH AREA CODE NIGHTS: NAME(LAST,FIRST) PHONE k WITH AREA CODE <br /> II. PROPERTY 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 ❑ FEDERAL-AGENCY <br /> Cl INDIVIDUAL ❑ COUNTYAGENCYCITY NAME STATE ZIP CODE PHONE k,WITH AREA CODE <br /> III. TANK OWNER INFORMATION &ADDRESS — (MUST BE COMPLETED) <br /> NAME CARE OF ADDRES INFORMATION <br /> me �' cc r c I T L- e � <br /> MAILING or STREET ADDRESS ✓Bax to indicate ❑ PARTNERSHIP STATE-AGENCY <br /> ❑ CORPORATION ❑ LOCAL-AGENCY ❑ FEDERAL-AGENCY <br /> ❑ INDIVIDUAL 13COUNTY-AGENCYCITY NAME STATE ZIP CODE PHONE k,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. ❑ II. ❑ 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&SIGNATURE) DATE <br /> LOCAL AGENCY USE ONLY <br /> COUNTY# JURISDICTION# AGENCY# FACILITY ID# #of TANKS at SITE <br /> I I q I o 010 1 O 0 <br /> CURRENT LOCAL AGENCY FACILITY ID# <br /> M& P, yo APPROVED BY NAME PHONE#WITH AREA CODE <br /> PERMIT NUMBER PERMIT APPROVAL DATE PERMIT EXPIRATION DATE <br /> LOCATION CODE CENSUS TRACT# SUPERVISOR-DI RIOT CODE BUSINESS PUN FILED DAT"llyl <br /> OYES NOCMECKM PERMIT AMOUNT SURCHARGE MOUNT FEE CODE RECEIPTM <br /> Miss <br /> THIS FORM MUST BE ACCOMPANIED BY AT LEAST(1)OR MORE TANK PERMIT FORM 'B'APPLICATION(S), UNLESS THIS IS A CHANGE OF SITE INFORMATION ONL <br /> FORM A(3-2-8B) <br /> \^} • DATA PROCESSING COPY <br />
The URL can be used to link to this page
Your browser does not support the video tag.