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RECMWE � / <br /> JUN 1 1 2009 <br /> lite(v <br /> tNVIMUINIVI i IILMLITI <br /> UNIFIED PROGRAM CONSOLIDATED FORM (�c:J� I <br /> L"4 <br /> UNDERGROUND STORAGE TANK PERNIIT/�-.N ICES <br /> OPERATING PERMIT APPLICATION—FACILITY INFORMATION <br /> (One form per facility) <br /> TYPE OF ACTION [1 1.NEW PERMIT JR S.CHANGE OF INFORMATION [3 7.PERMANENT FACILITY CLOSURE 4K <br /> (Chukanc hCon only) 0 3.RENEWAL PERMIT [3 6.TEMRARYFACILITY CLOSURE [3 9.TRANSFER PERMIT <br /> TOTAL NUMBER OF USTs AT FACILITYFAaImm# <br /> (Agency Use OW cj <br /> BUSINESS NAME(same uFAcHaYNAME ornaA-v,bgmeow Aa) 3. <br /> VER-Manteca CO <br /> BUSINESS SITE ADDRESS CITY <br /> 430 W. Center Street Manteca <br /> FAC ILITY 13 1.MOTOR VEHICLE Fummo 0 2 FM DISTRIBUTION 4M. Is the facility located an Indian Reservation or 4K <br /> 0 3.FARM 4,PROCESSOR W Ai.OTHER Twat lands? [3 Yes M No <br /> ...... ...... <br /> 4W- <br /> PROPERTY OWNER NAME PHONE 4W- <br /> Verizon California Incorporated FKA GTE California 800 386-9639 <br /> MAILING ADDRESS <br /> 112 Lakeview Cyn Rd <br /> CITY ate- STATE411. ZMpCODE <br /> Thousand Oaks A 91362 <br /> ........... <br /> TANK OPERATOR NAM 42M. PHONE 4Wt <br /> Verizon California, Inc. 909 620-5962 <br /> MAILING ADDRESS 428.3 <br /> 280 South Locust Street <br /> CITY M4 STATE 42M ZIP CODE 42" <br /> Pomona CA 91766 <br /> TANK OWNER NAME 414. PHONE 415. <br /> Verizon California, Inc. (909 620-5962 <br /> MAILING ADDRESS 416. <br /> 280 South Locust Street <br /> CITY 411. STATE 41& EP CODE 419. <br /> Pomona I CA 91766 <br /> OWNER TYPE: [3 4.LOCAL AGENCYAXSTRICI! ❑ 5.COUNTY AGENCY ❑ 6.STATE AGENCY 420. <br /> 0 7.FEDERAL AGENCY NON-GOVERNMENT <br /> .. ............ .............. <br /> TY(TK)HQ 44- rAli the Stain Bond of.Equaliza"Pud Tom Division.if mase am questioas. <br /> Issuopofmit and send legal notifications and mailings to: 0 1.FACILITY OWNER 13 4.TANK OPERATOR <br /> C1 3.TANK OWNER 13 S.FACILITY OPERATOR <br /> SUPERVISOROF DIVISION,SECTION,OR OFFICE(Required For Public Agencies Only) 4K <br /> CERTRICATION. I cerft 1h*the Womatim wy04 knAn ths sccuratand In tall can Hance with le gd MquirmentL <br /> =—- , llol — H0 <br /> DATE 6/9/09 E <br /> 9N09 <br /> P( ) 594-9850 <br /> ATIC 4A AFFLICANT'7111,11 <br /> MadTrTieNr;"eTda'Zt)ia (As Agent for Verizon) SunWest E.C. Inc. Project Assistant <br /> VPCF UST-A Rev.(I2/2007) <br />