Laserfiche WebLink
MAR-26-96 11 :54 FROM=TOSCO ENVIRONMENTAL ID:SI02772361 PACE 2/10 <br /> STATEWCAUMM4A94-STATE WATt <br /> UNDERGROUND STORAGE TANK PER APPLICATION•FORD A <br /> CO TM EACH F MTE <br /> MARK ONLY i NEW PERT Q 3 FemwAL Povar ® S Cmmm or woomAnoN CD 9 pmwm&74x4w 7m <br /> ONE MEIN ® 2 WrMWPUMT ® t XWM=ftWAfrQ 6 TBWORMW STH CLOS <br /> L FACIL.IIYMM INFORMAT10H&ADDRESS-(MUST BECOMPLETED) <br /> DU ORFAM M NAME NAME OF OPMIM <br /> Cass sTPT <br /> qtr of <br /> orry mum STATE CODE <br /> CMCCA <br /> v sox ®WMW Q PMMMW Q Q Q SIM&AMW <br /> TO QTS Doom <br /> •lo�wrcQUSTizsmpimrea /. E. uaca.ofsa�++oraear�am.w�aotl'w.�iAmeUSr <br /> TYPE 1 GAS STATM Q 2 OMIPMJMR ✓ AT10N ®0FTA AT SITE E P.A. %0.*(WVCMQ <br /> Q 3 FARM ED ®pRocEswR Q son T <br /> ACr COWACTPER" OMMapdmW <br /> - <br /> DAYS NAME(IAV Fow) iYA AF!SACR3D//E 00,Tp r %AST, is A <br /> 7RSA <br /> N&fM NAME MST.F a MM AREA C Naw&.Kwa wtm <br /> IL PROPERTY OWNER MATZOH- BE <br /> lCAN 01;ACCRESS MOMATION,&14455 �� <br /> MA@NG ai STRE.ET vmss r ©NMWJAL Q <br /> «rY <br /> UL TANK OWNER NFOHMATMN-MUST BE=WLETED) <br /> NAM6 OF OWNM <br /> T� AIC: CARE QF ADDRESS or tj► Tom► i cE <br /> MARAQG OR ACCAUS ✓ ka ® ® Q STA <br /> ' ,Q aC ✓ i8za� Q'' Q Q aXWr Y C. Acer <br /> trTNAM6 sTAcm PH awmeoAca <br /> 7Z_ .pQ <br /> Q /7- 2. <br /> IV.BOARD OF EQUALIZA71ON <br /> S LISP STORAGE EEE ACCOUNT NUMBER•CSA(916)322- <br /> TY(TK) HQ F4-W-I&[S a f7 III <br /> V PETROLEUM Uq FINANCIAL RESPONUMM- BE —WOMFY THE D(S) USED <br /> LFewo Q x C:33MOPAME p.SHWIT90W C3SWM0F0Mff 06600n= <br /> k� STATER�o <br /> Q i SATERA�a ORRI tCGltii� ®4 m mma woum Q io wmeon wowm Q ss o't o <br /> VL LEGAL NO TION AD Lee and w be lv tt*tank "A`s b=I a tt' <br /> lCM=04&9%WMA7M VO UADM ACOMMSMO=BE tSEDL 4® UL <br /> TFOSFUM HASBEFJr! PSVALTY OF PERARY,AND TO TW BES OF MY KN 15TREIEAAV <br /> TA/tlIC NAME $SNA T�4 �qQ/�1�7gT,t(g// DAT& WONTH10AYNGAR <br /> �j�i/"W171d1`G ALA5�Ll=L AGENCY USE Y <br /> 1UR! • F e 9dIT-- <br /> 7771 <br /> COUNTY t <br /> Q� Z, 7 1 1 Z 7(E l <br /> L000M CCOE-OPTRWAL cvms wAGTIr-o nxwAL -0P74,ft4L <br /> THIS FORM SEA ST ATLEAST(f)OR HORS S. >S A OF SrfE MOH QAR.Y. <br /> wad amemamm,vuumncurimmmn lTrwti JT Taw apmvi ATvmq <br />