COMPLIANCE INFO_FILE 11 - Laserfiche WebLink

Home Browse Search

UNIFIED PROGRAM CONSOLIDATED FORM TANKS t i UNDERGROUND STORAGE TANKS - FACILITY WGxtck,I- OF OF ACTION (one page per site) Page I of I ❑1.NEW SITE PLRIM T ❑i.RENEWAL PERMIT ®5.CHANGE OF INFORMATION ((]teck arc itum onl)) ❑7.Pl}LMANEKfLY CLOSED SITE ❑4.AMF.NOED PERMIT (Specify change,local use only.) I ❑8 TANK RFTfOvr:D ❑6 TEMPORARY SITE CLOSURE 40i I. FACILITY/SITE INFORMATION BUSINESS NAME(SameuFACLWLIIYN:utEoDHA-wieducv-essAsl j; FACILYNIDb Lawrence Livermore National Laboratory-S300 3 9 0 0 0 2 3 l 9 4 5 I NEARESTCROSS STREET got I FACILITY OWNER TYPE 4 Interstate 580 LCX AL AGF,\CYiD1STRICT• BUSINESS 1.GAS STATION 3.FARM1.5.COb1AfERCIAL I El 2.I DIV DUAL N ❑5.COUNTY AGENCY- TYPE ❑2.DISTRIBUTOR ❑4.PROCESSOR®6.OTHER aur ❑6.STATE AGENCY- TYPE 1'O"I'AL NUMBER OF TANKS ❑3.PARTNERSHIP ®7.FEDERAL AGENCY- Is facility on Indian Reservation or •If owner or UST is a public agency'name of supervise of d visirni,scp,on or ofTicc hi REMAINING AT SITE trust lands? operates the UST(Ibis is the contact prison for the tank records) 5 at S300 .a, ❑Yes ®No 401 William G.Hoppes IL PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407 PHONE U.S.Government-De artment of Enerev :cs MAILING OR STREET ADDRESS 510 637-I 809 1301 Clav Street 4,,4 CITY X10 S"f:1'fIi 411 "PCODE Oakland ['ROPERTI'OWNLR 1'Y'P[s CA ❑ 1.COR['URA'f10N ❑2.INDIVIDUAL ❑4.LOCAs.AGENCY I DIS'rRIC 1,208 6.S'FA'fG AGL'NC}' ❑3.PARTNERSHIP 115.COUNTY AGENCY ®7.FEDERAL AGENCY i'ANK U\VNER NAME11.1. TANK OWNER INFORMATION Lawrence Livennore National Laboratory i14 PHONE MAI LING OR STREET ADDRESS 925 422-015$ ('FLivermore U. 808,L-627;7000 East Avenue, L-627 I-Y41; STATE 418 ZIPCODG CANK O1lT1lR"1'YPI ❑ L C'UKPORA'fiC)N ❑2.INDIVIDUAL 94551-0808 ❑4.LCK:AL AGENCY I DISTRICT ❑6 STATE:AGENCY ❑3.PARTNERSHIP 1-:15.COUNTY.AGE'NC'Y ®7.PI:UI:KAI.AGI'N(,: -' IV. BOARD OF EQUALIZATION UST STORAGE FEF.ACCOUNT NU FIBER TY(TK)HO 44- ®Exempt Call(916L322-9669 if c uestions arise. V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE NIFTHOD(s) ❑ 1.SELF-INSURED ❑4.SI)RETY 110\D ❑7.SIAIIi FUND ❑2.GUARANTEE El 5.LETTER OF CREDIT C18.STATE FUND&CFO I.F.'f-I'F.R ❑99 UTIF IF. C t)\ I'\1FCIi:\XIS�1 ❑3.INSURANCE ®6.E)CEMPTION I ❑9.STATE'FUND K CD VL LEGAL NOTIFICATION ANDMAILING ADDRESS C'h-Ic.k une box to indicatewhich address should M used for legal nMificmions and ncohn¢ Legal neufications and maihnes will be sent to ehe tank owner unless cal I s?d checked ❑ I FACILITY ❑' 1'ROPf:RTY'O',VNiiK (JUNER VII. APPLICANT SIGNATURE Cerrificatim-.1 crt,ty that the mfortnaticn pruaid;d herein is true and accurate to the best of my knowledge. StGN,11'UR UFA' I AN --- DATE I '2a PHONF. ' l 0 2/2003 ,_ O l _S NAME OFA L f int) ��,1)477 426 ' TITLE OF APPLICANT William '.Hoppes Group Leader,Water Guidance and Monitoring Grot:p, jEn%ironmental Protection Department SPATE UST F:IC'[LLTI'Nt)MI31iR;rM +=s 1 1998 L'PGRA.DE CERTIFICATE NUMBER , UPCI:(1!99 revised) Formerlx'S\VRCH Form :\ r