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D <br />06/16/2003 11:58 2099316'43 WATERLOO SHELL <br />IJun 16 03 11!25a ice T. Marubash>i 208 <br />PAGE 02 <br />?7-5864 p•c <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />UNDERGROUND STORAGE TANKS - FACILITY <br />f wCTI(3N r 1. N!W 311E PERMT <br />j Chock Oro dom cr ly) <br />F2. NE'JY OPERATOR <br />Aa RENtd4AL PEPMIT <br />T 4 AYlNDEDPERIIYT <br />TANKS <br />(on► r>MB• per 9119) <br />1' S CNnNCE OF wFORraATgN (spriry enOrye 1, T PERNIANFNTIY CLOSED 4JITE <br />r B. TANK NEMO'!EO 400 <br />1 0. TEMPORARY arTE CLOSUR! <br />1 ea rlr ITV ! MTV 1►JCr%I3nAT1nbj <br />BUSINEBH NAVE 18orere 06 FAWU7Y NArAH or DBA- 012? 6600" A■) a <br />FACIL'TY ID>2t <br />Waterloo Shell, William Norby <br />ry'` <br />4313 Waleloo Rd, Stockton, CA 95205 <br />�_ <br />NEAR S7 CROSS8TREET 4Cf <br />FAU1TY�RTYPE <br />A. LOCAL AGENCY(DISTRICT • <br />�fWy S� <br />*X* 1. CDRPORATION <br />5, COUNV AGENCY' <br />1^ . IN()IVIPUAL <br />j A SYAT[AOENCY' <br />- <br />BUSINESS 7y" X 1, GAS STATION C 3. FARM <br />r 5, CONIMtRCWI <br />r' 7. PARTNERSHIP <br />) 7. FEDEI;M AGENCY' 4Q <br />101STRIBUTOR 4 PRDCFSSOR i- R D7HfR <br />403 <br />r TAL NUMBER OF TAN"Ic <br />tan11A on lnd� l R48"4111on or 'M —or of 118T II 9`c upl= Vmncr. nwo al wPrMecr of <br />'r.,■tlaMa' 01Ieonun a 11R-ce wham aporatw too UST. <br />REMAINING AT SITE <br />('1113 5'14 ca tw pv. .% lot Ino Iva wtrds.) <br />400 2 <br />F- Yt■ <br />X Nv 406 408 <br />V. PROPERTY OWNER INFORMATION <br />PROPERTY CINNER WWI 40" <br />PHONE 406 <br />SHELL OIL PRODUCTS US <br />C/0 Bruce T. Marubashl, H,S&F- Analyst <br />9257664498 <br />MMLINGOACTACfTADDRGBS 409 <br />P.O. BOX $604 <br />MM— 4-1 v <br />STATE al <br />SAN JOSE <br />CA <br />96165 <br />PROPERTY q T✓PE <br />2 INDrnDUA1 r 4 LOCAL AQENG`'r DtaT111GT <br />r6 STATE AGENCY 419 <br />v <br />X, OURPORA110N <br />[" d PAISTNERSNP i t. COUIITYAGENCY <br />FEDERALAOENCY <br />III- TANK OYIMER INFORMATION <br />TANK O'NNERNAInr 414 <br />SHONE 415 <br />SAME AS II <br />MALING OR VREV ADDn$$ 415 <br />CITY 417 <br />5TATF;41 <br />(P GDE 419 <br />TANK wNlR TYP! <br />2. MlDIYIDV AI I' 4. LOCAI AGENCY! DISTRICT <br />C' 6 STATE AGENCY 42c <br />1 1 CORPORATION <br />C PARTI�RSHIv r 5. CJUNiYAGENCY <br />r 7. FEDERA1.AfitENCY <br />TY (TK) 0'0 14 14 1 - 10 3191 of 21 if 1 Call (916) 322-9898 If queeliorle arias 411 <br />X 1. 3ELF4N5URED 4 SURETY BOND T STATEfUND <br />2 CUARANT=C i s LETTER OL CREDIT r G. 57A -E FUND 6 (:FO LETTER <br />T 3 INSVRANII. r 5 rxwp ION r B S7A7E PUNA 8 CO <br />.71V. LOCA1.GOV-TMEChAF4IW <br />6!. OTHER. <br />422 <br />C1rCk Ival ocx Itl IrIQIfA1B WI11G7 yta■ ■trould btr ualtl Wr N'£41 npJslalb■1a on�madlrny. e 3 <br />Lc9a1 r10t 1�Yif,1n4 anJ mPllnoi wn De ■ern to iM 1a�G Tv�t� „nlf■■ iOK t Pr 2 Ia ctackM. X 1 FACILITY r a. PR!'tPERTY 01MNEP r S TANKOYN4ER 2 <br />I- vu1PPLICAN1siGNAT,IRE: <br />COrINICOtol. I amimy Inet 1 l InrCIM*4P) FwcN j M Mn s trv• .rd ac-g W 1e ra -'t -�f my K—o d,. <br />SIGNAIU E OF APPI.:CA147 — OAT! ` 0 2 424 PHONE <br />923-798.3485 s:s <br />NAME OF APPLICANT (pant) TILE OF APPLICANT 427 <br />BRUCE T. MARU$ASHI for Shell 011 Products US 425 H,S&E Analyst <br />UPCF (1/8G revisal) <br />rFo.. v,• <br />=en <br />6 <br />Formerly SWA00 Form A <br />