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FIED PROGRAM CONSOLIDATED FO UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - FACILITY INFORMATION (One form per facility) TYPE OF ACTION ❑ 1. NEW PERMIT ® 5. CHANGE OF INFORMATION ❑ 7. PERMANENT FACILITY CLOSURE 400. (Check one item only) ❑ 3. RENEWAL PERMIT ❑ 6. TEMPORARY FACILITY CLOSURE ❑ 9. TRANSFER PERMIT I. FACILITY INFORMATION TOTAL NUMBER OF USTs AT FACILITY 404. FACILITY ID # 1. 1 (Agency Use Only) _ _ BUSINESS NAME (same as FACILITY NAME or DBA - Doing Business As) 3. N5TR, LLC, Hangar 2 BUSINESS SITE ADDRESS 103. CITY 104. 5000 South Lindber h Street, Hangar 2 Stockton FACILITY TYPE ❑ 1. MOTOR VEHICLE FUELING ❑ 2. FUEL DISTRIBUTION 403. Is the facility located on Indian Reservation or 405. ❑ 3. FARM ❑ 4. PROCESSOR ® 6. OTHER Trust lands? ❑ Yes ®No H. PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407. PHONE 408. San Joaquin County 209) 468-4700 MAILING ADDRESS 409. 5000 South Airport Way, Room 202 CITY 410. ST'AT'E 411. ZIP CODE 412. Stockton CA 95206 . TANK OPERATOR INFORMATION TANK OPERATOR NAME 428-1_ PHONE 428-2 N5TR, LLC (650) 341-1700 MAILING ADDRESS 428-3 1900O'Farrell Street, Suite 180 CITY 4284 428-5 ZIP CODE 428-6 ISTATE San Mateo CA 94403 . TANK OWNER INFORMATION TANK OWNER NAME 414. PHONE 415. 5TR, LLC (650) 341-1700 MAILING ADDRESS 416. 1900 O'Farrell Street, Suite 180 CITY 417. STATE 418. ZIP CODE 419. San Mateo CA 94403 OWNER TYPE: ❑ 4. LOCAL AGENCY/DISTRICT ❑ 5. COUNTY AGENCY ❑ 6. STATE AGENCY 420. ❑ 7. FEDERAL AGENCY 8. NON-GOVERNMENT V. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY (TK) HQ 44- ® 2 5 ® 3 2 Call the State Board of Equalization, Fuel Tax Division, if there are questions. 421. . PERMIT HOLDERI Issue permit and send legal notifications and mailings to: ® 1. FACILITY OWNER ❑ 4. TANK OPERATOR 423 ❑ 3. TANK OWNER ❑ 5. FACILITY OPERATOR SUPERVISOR OF DIVISION, SECTION, OR OFFICE (Required For Public Agencies Only) 406. APPLICANT SIGNATURE CERTIFICATION: I certify that the information provided herein is true, accurate, and in full compliance with legal requirements. APPLICANT S19VATURE DATE 424. PHONE 425. 1JA11V1,1 12, -14 /,OZ 12/8/2009 1 (209) 602-8271 APPLICANT (pri 426. APPLICANT TITLE 427 Jer . aer Aviation Manager //. r UPCF UST -A Rev. (12/2007)