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• e - ee e - • • e • e <br /> ealityj5fte . . ' <br /> e; <br /> AUBURN 7700 INC CERS ID <br /> 44 W MOSSDALE RD 10180551 <br /> THROP,CA 95330 <br /> W101- <br /> ubmltkal$t3U9eelm <br /> .,, <br /> Submitted on 6/9/2015 by pal dhaliwal of dixon chevron(Dixon,CA) <br /> i <br /> �ransfer Permit <br /> acility Inforrrtat�an � � - atik O'peratar �� <br /> UBURN 7700 INC Sksp inc(Pal Dhaliwal) <br /> 44 W MOSSDALE RD 916)708-1668 <br /> LATHROP,CA 95330 444 W Mossdale Rd <br /> acility Type Board of Equalization Account Number Lathrop,CA 95330 <br /> otor Vehicle Fueling 44041343 <br /> s the facility located on Indian Reservation/Trust lands? <br /> 0 <br /> = <br /> Ir <br /> ty Owner. , ... �;., ank Qwner .; <br /> �. .a <br /> Pal Dhaliwal SKSP INC(Pal Dhaliwal) <br /> 916)708-1668 916)708-1668 <br /> 809 Snelling Lane 3809 Snelling Lane <br /> acramento,ca 95835 Sacramento,CA 95835 <br /> Tank Owner Type <br /> Non-Government <br /> erm MW <br /> Holder lnforrttttrn <br /> ermit Holder Notification Information Supervisor of Division,Section,or Office(Required for Public Agencies Only) <br /> ank Owner <br /> fnancfal Responsibility Mechanfsm(i <br /> ndicate which approved mechanism(s)are being used to show financial responsibility either as contained in the federal regulations(40 CFR,Part 280,Subpart H,Sections 280.93 through <br /> 80.107)or CCR,Title 23,Division 3,Chapter 18,Section 2808.1. <br /> Self-insured Surety Bond State Fund and CFO Letter Other Mechanism <br /> Yes <br /> Guarantee Letter of Credit State Fund and CD <br /> Insurance Exemption Local Government Mechanism <br /> - <br /> pplican Certification <br /> pplicant Name Applicant Title Applicant Phone Date Certified <br /> Pal Dhaliwal Owner (916)708-1668 <br /> Printed on 6/9/2015 2:34 PM <br />