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UN _0 PROGRAM CONSOLIDATED F <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - FACILITY <br /> (one page per site) <br /> TYPE OF ACTION F 1.NEW SITE PERMIT r 3.RENEWAL PERMIT F 5.CHANGE OF INFORMATION(Specify change- r 7.PERMANENTLY CLOSED SITE <br /> (Check one item only) F 2.NEW OPERATORr 8.TANK REMOVED 400 O <br /> F 4.AMENDED PERMIT local use only)_New Format Request_ <br /> r 6.TEMPORARY SITE CLOSURE <br /> I.FACILITY/SITE INFORMATION 04 li, <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID# <br /> Q <br /> 99 Shell, Balaji & Chhala Angle <br /> Z 3 �\�\1 <br /> 7700 Moreland Court, Stockton, CA 95212 J <br /> 4 <br /> NEAREST CROSS STREET 401 FACILITY OWNER TYPE F 4 LOCAL AGENCY/DISTRICT- <br /> 1-99 & Hammer Lane X 1. CORPORATION F 5. COUNTYAGENCY- <br /> BUSINESS TYPE F 2. INDIVIDUAL r 6. STATE AGENCY' <br /> X 1.GAS STATION r 3.FARM F 5.COMMERCIAL r 3. PARTNERSHIP <br /> F 2.DISTRIBUTOR F 4.PROCESSOR F 6.OTHER F 7. FEDERAL AGENCY- 402 <br /> 403 <br /> TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'If owner of UST is a public agency:name of supervisor of <br /> REMAINING AT SITE trustlands? division,section or office which operates the UST. <br /> (This is the contact person for the tank records.) <br /> 404 4 F Yes X No 405 406 <br /> II.PROPERTY OWNER INFORMATION <br /> PROPERTY OWNER NAME 407 PHONE 408 <br /> EQUILON ENTERPRISES, LLC C/O Bruce T. Marubashi, Permit Analyst 925-766-3498 <br /> MAILING OR STREET ADDRESS 409 <br /> P.O. BOX 8509 <br /> rSANJOSE <br /> 410 STATE 411 ZIP CODE 412 <br /> CA 95155 <br /> PROPERTY OWNER TYPE F 2. INDIVIDUAL F 4. LOCAL AGENCY/DISTRICT F 6. STATE AGENCY 413 <br /> X 1 CORPORATION F 3. PARTNERSHIP F 5 COUNTYAGENCY F 7. FEDERAL AGENCY <br /> III.TANK OWNER INFORMATION <br /> TANK OWNER NAME 414 PHONE 415 <br /> SAME AS II <br /> MAILING OR STREET ADDRESS 416 <br /> CITY 417 STATE 418 ZIP CODE 419 <br /> TANK OWNER TYPE F 2. INDIVIDUAL r 4. LOCAL AGENCY/DISTRICT r 6. STATE AGENCY 420 <br /> F 1. CORPORATION F 3. PARTNERSHIP r 5. COUNTYAGENCY r 7. FEDERAL AGENCY <br /> TY(TK)HQ 1 4 1 4 0 3 1 9 0 2 6 1 Call(916)322-9669 if questions arise 421 <br /> INDICATE METHOD(S) r 1. SELF-INSURED F 4. SURETY BOND r 7. STATE FUND F 10. LOCAL GOV=T MECHANISM <br /> r 2. GUARANTEE F 5. LETTER OF CREDIT r 8. STATE FUND&CFO LETTER r 99. OTHER: <br /> X 3. INSURANCE IF 6. EXEMPTION r 9. STATE FUND&CD 422 <br /> Check one box to indicate which address should be used for legal notifications and mailing. X 1 FACILITY r 2. PROPERTY OWNER IF 3. TANK OWNER 423 <br /> Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. <br /> Certification: I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> IGNATU/LJ OF APPLICANT` DATE 424 PHONE <br /> C\J „ 12/6/01 925-766-3498 425 <br /> NAME OF APPLICANT(print) TITLE OF APPLICANT 427 <br /> BRUCE T. MARUBASHI for Equilon Enterprises, LLC 426 PERMIT ANALYST <br /> STATE UST FACILITY NUMBER(Forlocal use only) 428 1998 UPGRADE CERTIFICATE NUMBER(Forlocal use only) 429 <br /> UPCF(1/99 revised) 5 Formerly SWRCB Form A <br />