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le/.18/2000 09:32 2094683433 FIFTH FLOOR <br />I Am <br />PAGE 01 <br />TANKS <br />UNDERGROUND STORAGE TANKS.— FACILITY rove petp wAte) <br />Prpe <br />TYPE OF ACTION r 1. NEW SITE PERMIT r t RENEWAL PERMIT IX 5. CHANGE OF INFORMATION (SPS' dteme ` <br />r P, PERMANENTLY CLOSED SITE <br />r a- -rA dK PE mavED Am <br />(Cfto am ftm Coy) r 4, AMENDED PERMIT R" un <br />r S. TEMPORARY $ITE CLOSURE <br />F-' APILI ;YY WE INFORMATICIV <br />BUSINESS NAME (Same as FACILITY NAME Cr flak - OokV Business AS) 3 I A- <br />Sheriffrs Oj2erations Center & Ja' <br />FAC1LTfY OWNER TYPE <br />r 6. LOCAL AGENCY/DISTRICr <br />NEAREST CROSS STREET 4O, <br />Michael N. Canlis Boulevard r I. ca"0N <br />S. COUNTYAGENCY- <br />SUSINESSTYPE r 1. GAS STATION r 3. FAw r 5. COMMERCUIL r 7. INDIVIDUAL <br />r6. STATE AGENCY - <br />r 2. DISTRIBUTOR r a. PROCESSOR M OTHER - r 3. PARTNERSHIP <br />r 7. FEDERAL p.GGNCr 4� <br />403 <br />AL NUMBER OF TANKS (� taciiryr a+ Indian Raeervaeon Of -0 owemr of U5T 6 a put6c agwW r» t# 8AMMS W d <br />dclrisen, L9C1 T W a" tvfden OpRatw <br />Bob - C awe l t i <br />®Oandt7 <br />REMAINING AT SrM (TllrelaftCOVaaParwnfor the W* <br />Government Buildings: <br />404 2 r Yea No 405 <br />• -.. n. PROPERTY OVWNER'INFORMATION= <br />..,PHONE <br />. . ... <br />4" <br />PROPERTY OWNER NAME 407 <br />Ran Maauin County Sheriff's 0 enation nter & Jail Com <br />- <br />French Camp <br />PERTY OWNER TYPE <br />PROr 2. WOMDUAL <br />r d LOCAL AGENCY! DISTRICT r 8. STATE AGENCY 413 <br />r t. CORPORATION r 3. PARTNERSHIP ]X6. COUNTY AGENCY r 7. FEDERAL AGENCY <br />" . aIL TANK OWNER INFORMATION` <br />p� 4t5 <br />TANK OWNER NAME ata <br />--SAME AS ABOVE -- <br />TANK OWNER TYPE r 2 INDIVIDUALr 4. LOCAL AGENCY I DISTRICT r 6. STATE AGENCY &M <br />r t, CORPORATION r' 3. PARTNERSHIP r 5. COUNTYAGENCY r 7. FEDERAL AGENCY <br />a21 <br />TY (TK) HO 1 a 1 a 1 - to] 4 0 2 5 Call (916) 322-2669 if questions arise <br />imoia E METHOO(S}r , SELF=INCUREO I' 4. suRErr tIOND <br />M STATE FUND r 10: LOCAL GOY.T MECHANISM <br />r z GUARANTEE r 5. LETTER OF CREDIT r a. STATE FUND & CFO LETTER r ae. OTHER: 422 <br />r 3. INSURANCE r 6. EXEMPTION r 4. STATE FUND $ CO <br />V r K OVMER A23 <br />and alai - - � a a. T...-�......�.. --- <br />ca. ambos u .+d cats aMh•addeeaa m+ou!d ee IpaO'tar MpYd �. ,. FACILITY Z. <br />5 Formerty SWRCS Ferm A <br />UPCF (1199 revised) <br />