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BILLING 2006 - 2011
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0506504
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BILLING 2006 - 2011
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Entry Properties
Last modified
12/13/2023 12:49:00 PM
Creation date
5/10/2019 4:02:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
2006 - 2011
RECORD_ID
PR0506504
PE
2361
FACILITY_ID
FA0007464
FACILITY_NAME
MAIN STREET ARCO AM PM*
STREET_NUMBER
1100
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95337
APN
22119062
CURRENT_STATUS
01
SITE_LOCATION
1100 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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• 'UNIFIED PROGRAM CONSOLIDATED FORM D <br /> TANKS F_ <br /> N <br /> UNDERGROUND STORAGE TANKS - FACILITYP���1��t 6 � $,l3►� B8 <br /> (oP g Pe <br /> TYPE OF ACTION [11.NEW PERMITS.RENEWAL PERMIT Q S.CHANGE OF INFORMATION ❑7.PER�A� t;CQ� 400. <br /> (Check one item only) 4.AMENDED PERMIT (Specify change) ❑8.T <br /> ❑6.TEMPORARY SITE CLOSURE <br /> • �r ce 4I;r s f r t r x r s u. a . <br /> .. , �� c 0R1VTA�'Irx aS <br /> Lr �s- <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Rosiness As) FACILITY <br /> MkIN ''MEET Ake A M P M- V-js e LrL`P1�s IDM pr 010 0 1 J,+ G 41 <br /> NEAREST CROSS STREET 401 FACILITY OWNER TYPE ❑4.LOCAL AGENCY/DISTRICT* 402. <br /> S. MA iN STP-GET M im TEU1 ❑ 1.CORPORATION ❑5.COUNTY AGENCY* <br /> BUSINESS I.GAS STATION ❑3.FARM ❑5.COMMERCIAL 403. ❑2.INDIVIDUALL El 6.STATE AGENCY* <br /> TYPE 2.DISTRIBUTOR El4.PROCESSOR El 6.OTHER 3.PARTNERSHIP L�' ❑7.FEDERAL AGENCY* <br /> TOTAL NUMBER OF TANKS 404. Is facility on Indian Reservation 405. •If owner of UST is a public agency: name of supervisor of division,section or 406. <br /> REMAINING AT SITE or trust lands? office which operates the UST. (This is the contact person for the tank records.) <br /> �j ❑Yes 9No <br /> � c�r° 3:Esc ^ ..77�r, 'p��•y -1"',''r-�_g7,r/t i3 'x3/,�n-. %r�`7+�z1/ly7�rgrr '�' ..,e.Wie <br /> 41 <br /> �r <br /> F.: ";r. �..;.ti <br /> r wi'h." 7' s-7A3:..,-viz- V. <br /> ,_?;ve,-r"yE '. �. ✓�. e .aa_ _ ! <br /> PROPERTY OWNER NAME 407. PHONE 408. <br /> . J>:sV_vL_ tuTeF_PK(SE LLG �Sl�)Zg6-3y7o <br /> MAILING OR STREET ADDRESS 409. <br /> (o-1 [ FAP44ES L{4NE <br /> CITY 410. STATE 411. ZIP CODE / 412. <br /> r(LENLoNT C.A 8453 <br /> PROPERTY OWNER TYPE ❑ 1.CORPORATION ❑2.INDIVIDUAL ❑4.LOCAL AGENCY/DISTRICT EJ6.STATEAGENCY 413. <br /> LL C, ❑3.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.FEDERAL AGENCY <br /> e yr O <br /> F. <br /> -.< 4r. <br /> � .. ti. _ <br /> ( TANK OWNER NAME414. PHONE 415. <br /> V-J$ ENTeiL9L1SE LLC- VSN MAIN STILEET AkED hryl D►�l (2_0q) 87_5- C., Lf <br /> MAILING OR STREET ADDRESS 416. <br /> R <br /> 1100 5. MAIO S`rP,EET <br /> CITY 4n. STATE 418. ZIP CODE 419. <br /> M prt'31t--C_h C X 9 S 33-1 <br /> TANK OWNER TYPE ❑ 1.CORPORATION El 2.INDIVIDUAL C_ El 4.LOCAL AGENCY/DISTRICT 6.STATE AGENCY 420. <br /> 3.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.FEDERAL AGENCY <br /> MEN_!" <br /> TY TK)HQ 44 0 - Call(916)322-9669 if questions arise 421 <br /> s '` t7'L, .f....- 3.3^`"_iL ";Q:S> <br /> Nme- y'i'n+ S"i >s rr 6`('._'.' 'C `` r .lilwl' 'rt .d, 7 .(.. '.Sk.•" h7 <br /> 7 � � i' � 4 F -_: JAL" <br /> _ :y. t rq r �A 7t.^rd si _ a•'_ _:,r <br /> INDICATE METHOD(s) ❑ I.SELF-INSURED ❑4.SURETY BOND ❑7.STATE FUND ❑10.LOCAL GOVT MECHANISM 422 <br /> [12.GUARANTEE ❑5.LETTER OF CREDIT8.STATE FUND&CFO LETTER ❑99.OTHER: <br /> [13.INSURANCE El 6.EXEMPTION T9.STATE FUND&CD <br /> 1 b�rt�fn�y�tom/ T 7�rs: ,fie z�yg�r[gn7� p �a 3y a ; y t <br /> r J 7µ.i Y7`.�L, i.r r'�„-3.,F c�iA .4✓_:i"",..5. C.x_ _ -�"+r-h .+3:-. "'..-r. _ ''t- �ix.a�?��-:. �, _�t�i ��;� _ C9_� -� <br /> Check one box to indicate which address should be used for legal notifications and mailing. <br /> Legal notifications and mailings will be sent to the tank owner unless box I or 2 is checked. 1.FACILITY El 2. PROPERTY OWNER ❑3.TANK OWNER 423 <br /> VII APPLICANT SIGIATU�tE <br /> Certification: I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNAT11 F f) PPLICANT DATE 424. PHONE 425. <br /> 12 Ltl\ob <br /> NAME OF APPLICANT(pi int) -p 426. TITLE OF APPLICANT 427, <br /> V.UL1bEEP C. - Si-JA(k�Pr IMEM4Elt OWiJEIL OF LLC. <br /> (, >TATE UST FACILITY NUMBER(Agency use only) 428. 1998 UPGRADE CERTIFICATE NUM BER(Agency use only) 41;. <br /> (See Data Element 1,above. <br /> UPCF Hwfwrc-a(1/99)-1/2 http://wwiv.unidoes.org Rev.02/16/00 <br />
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