Laserfiche WebLink
06/03/2004 09:23 9166352606 TAIT PAGE 02 <br /> -nmTmwjft Jp1pF%&-XP A"*-"T.Yqs**%y a A nrWTW we"PI&N <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - FACILE <br /> (one page P-skc) Fags <br /> -3 MMO <br /> rTYPE OF ACTION 19 1.NEW UMPERM117 0 .REN WAL PERMF.r E3 MUMM RMAMN I 7YERMANINILY crmm sm <br /> (Okolc cm J%M n"b,) 0 4.ANIEMMPERW Vocify�oiiigc lucid nib S.TAM AMOVM <br /> 0&TEMPORARY 3M MMURE 4M <br /> L FACILITY/SITE EOVRMATION <br /> BUSINESS NA?VM Clamm FACMrrT NAM or D13A-Doingius"AS) 3 pActr-rrym# <br /> SBC Services*ESCLCAI I I i <br /> NEAREST CROSS STREET 40t FAQ 4.LocAL4GENCY/D1STR1CT* <br /> Secmd St ER 1,CORPORATION E3 5.COUNTY AGENCY* <br /> BUSINESS ET-1.GAS STATION 3.FARM U S. COM34ERCTPJ- [1 2.INDIVIDUAL ❑6.STATE AGENCY* <br /> TYPE ❑2,DISIRIBUTOR. [14.PROCESSOR 0 6. OTHER 4o3 0 3.PARTNERSHIP ❑7.FEDERAL AGENCY0 492 <br /> TOTAL NUMBER OF TANKS Is facility m Indian iEciorvdion or *Uoww afU3T ir a public amor.nomo nfpvm#vkor of4livisloo,644MM of office Which <br /> REMAINING AT SITE ututlands? opendm the UST(Mg is op cpuhwt pomm for tho tirok fom4s.) 40d <br /> 0 404 0 Ycs 0 No 405 <br /> u. PROPERTY OWNER 0"RMATION <br /> PROPERTY OWNER NAME 40 PFIONE 468 <br /> SBC 800 757-6575 <br /> h1AIL[NG OR ST?JMT AID13RESS 40 <br /> 2600 Camino Ramon,RuL 3E000 <br /> My �AT9 at t ZIP COIF 412 <br /> &m Ramon CA 94583 <br /> PROPERTY OWNER.TYPE 19 1.CORPORATION [12.INDIVIDUAL 4.LOCAL AGENCY/DISTRICT U6-STATZAGENCY <br /> [:]3.PARTNERSHIP [3 5.COUNTY AGENCY 13 7.FEDERAL AGENCY 413 <br /> IM TANK OWNER EWORMATION <br /> TANK OWNER NAME 414 PHONE 415 <br /> SBC semoes (900)757-6575 <br /> MAMING Olt STR=r ADDRESS 416 <br /> 2600 Camino Ramon Rm 3E000 <br /> CITY 417STA <br /> _I TE 418 ZtP CODE 419 <br /> San RamonCA 94383 <br /> TANKOVVNERTYPE D9 1.CORPORATION 2..INDIVIDUAL U 4.LOCAL AGENCY DISTRICT 0 6.STATE AMNCY 420 <br /> E3 3.PARTNERSHIP 0 5.COUNTY AGENCY 0 7.FEDERAL AGENCY <br /> IV.BOARD OF)EQlUALIZATION UST STORAGE FEE ACCOUNT NUMER <br /> TYCT�ILQ-447-1-jj 1-19 1 4 ....... .......... CaH(916)322-%69 if moons mise 421 <br /> V.PETROLEAM UST MANCIAL RESPONSIBILITY <br /> INDICATE,METHOD(s) 19 1.SIELF-COLW50 0 4.SURETY BOND 0 7.STATE FUND 13 10,LOCAL GOVT MECHANISM <br /> 0 2.GUARANTEE [J S.LE`rMR.OF CREDIT 0&STATE FUND&CFO LE=R. 0 99.OTHEIL- <br /> 13 3.INSURANCE 136.EXEMMON El 9.STATE FUND&CD 42 <br /> VL LEGAL NOT137CATION AND MAILING ADDRESS <br /> Check one lox to isdivilbwhich dLddrw;o xl;add U Hoodfar legal anifficaMom and umifio& <br /> Lopl vWfiovioas and unRiop will be goat to the tank owner wilm box I or 2 is clmkc& [3 1.FAamff 0 1 PRQMTY OWNF.9 IM 3.TANK OWNER 423 <br /> VU.APPLICANT SIGNATURE <br /> Cettification-I certify that the kfanvagnA pram limmin is true and RdOurato to the 101-d u(tuy knowledge. <br /> SICiNA OF APPLIC, DATE 424 PHONE 425 <br /> 10/16/03 (916)635-2444 <br /> NAAO 017 AfP1,lCAW(pint)p 426 TITLE OF APPLICANT 421 <br /> Amy C.Dy Agem for Owner <br /> ILSTATE UV FACILITY MMBM Twiftuivac ants) I"S UPGRADE MRMCAV.NU?-,MR.(Pa).mL m.arty) 429 <br /> T TPr.F I1/Q()rpwqeAl 171 FoTmer1v,9VM CR Fhrm A <br /> 1 <br />