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m4v�30�� <br />UNIFIED PROGRAM CONSOLIDATFI) FORM t�k <br />�NDVRGROUND ST0RA(.,,F',TANK <br />t' <br />OPERATING PERMIT APPLICATION — FACILITY INFORMATION <br />(One form per facility) <br />I YFE (4 AC I ION C3 L \UkV VERMII i. CI JANGE OF INFORMATION 7, PERMANEN I FACIH FY( LOSI IRI <br />4 ',. RENT WAJ.PI.RMIT I EMPORARY F NCILI I Y CLOSURE' 0 (J. -1 RAiNSFFR PERMIT <br />1. FACILITY INFORMATION <br />FAC11,11Y <br />FACR 1-1-Y <br />1W1d\I-41; NVII Soiii' Iii I ewilin; Awn( w- i. 0,hg ffiisin('.4.5Av <br />Verizon California, Inc. - Manteca CO <br />CITY <br />430 West Center Street Manteca <br />I "w1l I IY rYllt 0 1 Ft EL DISTR 113t FION <br />Is the facilit-v located on Indian Reservation of <br />0 3� FARM ❑F1 4. PROCESSOR 0 (�,OTIIER <br />Crust land"' f I. YesNo <br />--4 <br />11. PROPERTY OWNER INFORMATION i <br />tt P1,11 I Y OWNEP NANME <br />PIIoNF <br />Verizon California Inc. (FKA GTE California) <br />(800)386-9 639 <br />11333 Sepulveda Blvd. <br />STATE <br />zip Com", <br />Mission Hills <br />CA <br />90045 <br />Ill. TANK OPERATOR INFORMATION <br />()Pt it NAMEazs=PHONE <br />-Verizon <br />California Inc. <br />1(909) 620-5498 <br />MAILIN6 ADDRESS <br />P.0 Box 725 <br />( HN <br />S FA IT <br />ZIP CODE <br />Chino <br />I CA <br />191708 <br />IV. TANK OWNER INFORMATION <br />TANK OWNFR NANII: <br />PHONE <br />Verizon California Inc. <br />(909) 620-5498 <br />NIAII INO ADDK(:'S',' <br />P.O Box 725 <br />11' STATE ZIP CODE <br />Chino CA 91708 <br />1 <br />(WV\&,R I* N Pf-: El 4. LOCA 1, A(3 IzNC Y: DIS I R K'T 0 5.COI,N1'YA(,'FN(-Y 0 6. S I'A I -F AGE-NCY <br />7.17TI)FRAL AGENCY 0 X. NON CiOVF,,.RNI,11.-,\- I <br />V. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br />P,' ( FK) t IQ 44- 1 0 1 OTTI 5 121 6 1 (,'at I the Statc Bowl ion, Full 'I ax Division, IF I1wi c i i,-- q tl,�t I (I,. <br />VI. PERMIT HOLDER INFORMATION <br />J%I,tivol -nld,00d lqzIl flolificmioll& and mailting, to 0 1, FACILITY OWNER 0 4 1 k iwl 1f, <br />1,TANKOWNL-R <br />t. PL1I —,,,IsoR of 1)1,v I JUN. OR OFFICE rRequitiedjo- l'ublicAgoicies 01do <br />1. APPLICANT SIGNATURE <br />------ ------ <br />(LR-F1FIC,VJ10N-. I herein isirue. accurate, incl in run eomvlwit,ohjtr.0 <br />5ITI,f( ANA ';16NV DA I I - <br />_WR F <br />9/04/2008 9 0�, 62 498 <br />It AN I \,1 I 'Kip, APPIV ��V IHII- <br />Zachwy,..FNngof as agent for Verizon Environmental fvlaraqer <br />I H, F I � S1 - % Rev. - L!2 riiNNN.uviidocsor� <br />