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10/18/2000 09:32 2094683433 FIFTH FLOOR PAGE 01 J t) <br /> UNIFtao PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - FACILITY <br /> (one page per site) <br /> TYPE OF ACTION r I.NEW SITE PERMIT 1 3,RENEWAL PERMIT 1X5.CK WGE OF INFORMATION(SpaOr ehanpe- r Y,PERMANENTLY CLOSED SITE <br /> (Cheek one Item tolyl r 4.AMENDED PERMIT a*un 0*)_ r 8.TANK REMOVED 400 <br /> r 6.TEMPORARY SITE CLOSURE <br /> 1:;FIIOIL-I'TY7 SITE'fNFORMATION <br /> OVS94OSS NAME(SO-0 as FACILITY NAME Cr 06A•001%0"rO tAS) 3 I • <br /> Sheriff's Operations Center & Jail Comple <br /> NEAREST CROSS STREETFACILITY OWNER TYPE r 4 LOCAL AGENCYIDISTRMT- <br /> Michael N. Canlis Boulevard r I CORPORATION J°S. COUNTYAGENCY- <br /> SUSINESS TYPE r t.GAS STATION r 3.FARMI�sT��S�.COMMERCVLL r 2. INDNtOUAL r 6. STATE AGENCY' <br /> r 2.DISTRIBUTOR r 4.PROCESSOR 1%.OTHER 1'3.PARTNERSHIP r T. FEDERAL AGENCY' 402 <br /> 403 <br /> AL NUM6ER OF TANKS Is faeilty oo IndOan Reft"Suon or 91 ownor of UST is puWc syenW..nems of a wm*w of Bob C awe l t i <br /> REMAINING AT SITE WeU nw dmian,section of office whlCtt pperel-the UST. <br /> (TMeathe Cat>eectaananfor the la*fWA)rds.) Government Buildings:: <br /> 404 2 r Yei No 405 <br /> P.PROPERTY OVWNER'INFORMATION <br /> PROPERTY OWNER NAME 407 PHONE 409 <br /> San JOa uin County Sheriff's Operations Center & Jail Com le 2 9)468-4400 <br /> MAILING OR STREET ADDRESS 409 <br /> 7000 Michael N. C e r <br /> 410 <br /> [ZTA 411 ZIP CODE 412 <br /> French Camp Calif. 952 1 <br /> PROPERTY OWNER TYPE r 2. INDIVIDUAL r4 LOCAL AGENCY I DISTRICT r 6. STATE AGENCY 413 <br /> r 1. CORPOmnON r 3. PARTNERSHIP 17,6, COUNTY AGENCY 1-.7. FEDERAL AGENCY <br /> :IU:TANK OWNER MFORMATION <br /> TANK OWNERNAME ata _ P d15 <br /> --SAME AS ABOVE -- <br /> MAILING OR STREET ADDRESS 415CrTY - <br /> 417 IA 418 ZIP CODE 41 <br /> TANK OWNER TYPE r 2 INDIVIDUAL r a. LOCAL AGENCY I DISTRICT r 6. STATE AGENCY 420 <br /> T' CORPORATION r 3.PARTNERSHIP r 5 COUNTYAGENCY r 7. PEDERALAOENCY <br /> TY(TK)HO 4 4 - 0,4 0 2 5 Call(916)322-96691'f questions arise 421 <br /> INDICATE METNOD(S} r t. SELF-INCURED r 4. SURETY WW M. STATE FUND r t0: LOCAL taOY-T MECMANOSM <br /> r 2 GUARANTEE r 5. LETTER OF CREDIT r a. STATE FUND d CFO LETTER r 99. OTHER <br /> r 3.INSURANCE r 6. Eam nON r 9. STATE FUND a CD 4T2 <br /> Cn txle box a in6c ea wn.ad&M'0WA DO we0'W 00 notfat+aha and^tail ft! 1't. FACILITY r 2. PROPERTY OWNER r 3.TANK OWNER 423 <br /> and ffirgrAl wju be lent to tMo tank <br /> CaffCapm I or" pmvdad the end beat of my kn wleepe. .. <br /> SIGNATURE OF 17 <br /> I TE ata PHONE 423 <br /> i 11-A •�� (209)4 8-4637 <br /> NAME OF APPLICANT farfrO 428 TITLE OF APPLICANT627 <br /> Bob Cawelti Dist. Maint. & Const. Supt- <br /> STATE UST FACILRY NWKR(For APcgi asa only) 428 1916 UPGRADE CERTIFICATE-NUMBER(F1r 6W use ewy) 429 <br /> UPCF(I M9 revised) 5 Formerly SWRCS Farm A <br /> } <br />