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Mar-12-03 05 : 39P Wo ey Oil , Inc . 20 48 07 �'�-�' P_ 14 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - FACILITY � <br /> (onc page per sitc) Page, ... of- <br /> Ell <br /> f❑3 Rl.\hal::\L I'RRAdI'I 05 CHANGE c)F IN ORMATION ❑ 'I'!-lih':\`SkiN'I'1_}"('LUSIiU SIT!°. <br /> (('heck one item onlv1 ❑4 ANIHNDh:D Pl•:RK4I'I speclty chance local ase:nh ❑ F,1NI:Rh 404'F.IJ <br /> ❑o.'1'IiMPOR,\dtl'seed•:tI,c>suRr; ,uta <br /> fA 3 9 7& I. FACILITY/SITE INFORMATION <br /> 13USINESS NAME«unc.,. -t n.ri l n lite.,,ul+� tn+,nK tar Inc .,A.) 3 I•:\C'l1.t71' Ill-+ --T <br /> t <br /> Valley Pacific Petroleum Sen ices- Inc Charier — <br /> NEAREST CROSS SPREE' -- - — t01 FAC'll d'i 'OWNER'rl'PF. ❑4.1 <br /> Fresno Ave d)c l lir i 11C v}CV S — ® 1.CORPORATION ❑s.C01-\-I YAGENCY* <br /> BUSINESS 01.0ASSTATION ❑3.FARNI ®5. COMMRRCIAL ❑ 2.INDiVIDUAL ❑6. IXIII..AC;ENCYI <br /> Tl PI'. ❑2.DISTRIBI-TOR [14.PR(K ERSOR❑& OTHER u;3 ❑ 3.1"ARTNFRS1311' Q 7,FEDI RAL AGENCY* 1102 <br /> 1'OT•1I,NUMBER OP'r:\N KS [s tucilit�'on Indian Rascrvation or *It owner of U4l i.a public agency mime t ut r h i,rrn.sa lion or office which <br /> REMAINING ATSITE ,nistlands- operates the LIS 1(I'his is the eont,,ct person for the nmk r .ads) <br /> 2 of ❑ Yes ® No 105 Ilk, <br /> It. PROPERTY OWNER INFORMATION <br /> PROPERTY OWNER is AN11% - "" 1,11MV aux <br /> Fran McPherson (209)941-4934 <br /> MAILING OR s-rREN.•r wmxrss _ .----____-- 1109 <br /> 1501 W. Charter Wal' <br /> CITY .nt ..STATE, 41, <br /> /,11'C011I' 4 i 2 <br /> Stockton -- CA-- 9521_)6 <br /> PROPERTY OWN ER T)PI: ® I COR POR TION ❑2.INDI VIDL Al: ❑4.LOCAL AGENCS DISI RIC I Q r,.,SIA E UF,NC Y <br /> ❑3.PARTNERSHiP ❑S.COUNTY A6ENCI' ❑7 I EDFRAL AGENCY 113 <br /> III. TANK OWNER INFORMATION <br /> TANK OWN,ERNAME 111 Pi1O';I; Its <br /> Valley Pacific Petroleum Services. Inc (zo9)e 18-9412 <br /> MAILING OR STREET ADDRLSs <br /> 116 <br /> 166 Frank West Circle <br /> CITY - --- - - 11'' STATE 418 ZIP CODE - 411.) <br /> Stockton _ _ CA — 95206 _ <br /> CAN[+014'NL:R`I'1"i'1'. ® ] CORPORATION ❑2.INDIVIDUAL ❑4.LOCAL AGENCY'DIS STRICT ❑o.S'l'\'I I'AGENCY 120 <br /> ❑3.PARTNERSHIP [15.C'OI N'1')-AGENCY ❑7 1:1!DLRAI•:1GIiNCI' <br /> IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> TY(TK)HQ 44- _Call(916)322-9669 if questions arise 421 <br /> V. PETROLEUM UST FINANCIAL RESPONSIBILITY <br /> [NDICATL;ME 11101)(s) ❑ I.SFH`-1N51 RED p a.Sl*RI'rY BOND ❑7.STATE F1 1N ❑ M.1.0CA1.GOVT MFCIIANISk,1 <br /> ❑z.G( :vr:\:rhh: El 5.1.1.[7ER OF CREDIT M 9.STNII,FUND K CFO 1,FITTER ❑ 99.OTIIFR: <br /> ❑3 INSFRANCE ❑6.EXEMPTION ❑9.STATE FUN D&Cl) 414 <br /> VI. LEGAL NOTIFICATION AND MAILING ADDRESS <br /> Checkone box to indicate which nddrc>s,h1•old bo used for legal notdi"tions and mailing <br /> Legal notifications and mailings will br ow io thc trek owner untcav box I n,2 is checked ❑ L FACIIA I N ❑2 PROPER-I.'t ,tl+t,11-:K ® I ANK OWNER 123 <br /> VIL APPLICANT SIGNATURE <br /> Certification I cenav,.hal the inl'ormanon provided hcicm is true and accurrte to the h-1 of m.v knowledge --- — – --- - <br /> SIGNATlt PLiC'AN'l DA'I'Ii 12'i PIIONI. 425 <br /> NA. EE OF-APPLICANT(print) 72r TITI:E OF APPI:IC ANT 1 az <br /> A/' I <br /> C <br /> e ("i Gn <br /> STATE USIFACH.rrl'N1t11131{Rtl rinc.,lu,enct}; 'oA 19981?PC;RAUI;C'l:Et'I'[3'IC':\1'IcN't'. 13h:K i,ih":,du> only) 429 <br />