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06/03/2004 09:16 9166352606 TAIT PAGE 02 <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - FACEMY <br /> (ma page pw site) Pasc Of <br /> n �111, <br /> TYPE OPACTION 11 1,MWSrM 3.VMWAL PERNUr N S. C$(v DwoRMATJON 0 7MGMNEMY CLOSED <br /> (Check me item nalbr) 4,AWMMXD PERNMT qmaify dimp local am Only E3 LTANK RWQVL7V <br /> E3 6.Tvvnpop-Axy SrM CLOSURE 4W <br /> L FACILITY/SITE INFORMATION <br /> FAIMLITY1W <br /> SBC Services 4ESCLCAI 1 <br /> NEAREST CROSS STREET 401 FAC UZrY OV44SR TYPE <br /> Second.SL IM 1.CORPORATION 5.COUNTY AGENCY, <br /> BusrNF-ss 0 1.oAs STATION Q 3.FARM Lj:f COMMERCIAL 0 7. RMIVMUAL 0 6.STATE AGENCY* <br /> TYPE [3 2.DISTRIBUTOR [14.PROCESSORS 6. OTHM 4o-.4 0 3.PARTNERSHIP (:]7.FEDERAL AGENCY* 402 <br /> TOTAL NUMBER OF TANKS Is facial an Indian Ibmicrydica of qVowaw ofUSr is a plibik sipmucy,paums aftdpervisor of4i0i9ion,mougap or afRoe Which <br /> REMATNING AT SrM tnmfands? op"cs dw uFr(nfx i.itba ovinact"am ferou tock mooritc.) <br /> AM 1 0 Ycs 0 No <br /> IF. PROPERTY OVVNER EqWRMATION <br /> PROPERTY OVINERNAW -461 1 PHONE AN <br /> SIX sewices (800)757-6575 <br /> MAnIN43 OR STREET ADDRESS 40 <br /> 2600 Camino Ramon,Rm.3E000 <br /> CITY 4tO STATE 412 <br /> San Ramon I CA 94583 <br /> PROPERTY owNER TYPE N I.coOammm 0 2.mrVIDUAT, [14.LOCTLE AGENCY/DISTRICT [16.STATE AGENCY <br /> 0 3,PARTNERSHIP' E3 5.COUNTY AGENCY 0 7.FEDERAL AGENCY 413 <br /> IR TANK OVVNER INFORMATION <br /> TANK OWNER NAME 414 PHONE At$ <br /> SBC Services (800)757-6575 <br /> MAILM OR STREET ADDRESS 416 <br /> 2600 Camino Ptsmort.Rm 3E000 -- ZV?CODE 419 <br /> CITY 411 STATE 412 <br /> San Ramon I CA 94583 <br /> TANK OWNER TYPE I.CORPORATION 0 2.INDBWUAL 0 4.LOCAL AGENCY DISTRICT E)6.STATE.AGENCY no <br /> C3 31.rARTNURSW 0 5.COUN-rY AGENCY 0 7.FEDERAL AGENCY <br /> IV.BOARD OF EQUALM77014 UST STORAGE FEE ACCOUNT NUMBER <br /> TYMM 44- _I 3 1 1 -19- [ 1-r4 I Call(916 322-9669 if 'ons arise lei <br /> V.PETROLEUM UST)A'INANCIAL RESPONSIBILITY <br /> JJ!ND1:CATE METHOD(s) 01.SELF-INSMI) 0 4.SUO.'rY BOND [3 7.STATE FUND 0 1 o.j=AL r-ovT mEcHAmsm <br /> 0 2.GUARANTEE 0 5.tErTER.OF CREDIT [I&STATE FUND&cF0 tETTER F-1 OTHER: <br /> 133.INSURANCE 0 6.ExmvimoN 0 9.STATE,FUND&cD 4n <br /> VL LEGAL NOTIFICATION AND AfAmNG ADDRESS <br /> Check one WX to wicato Wkich W&M should he wed flittept inowomitifts avammirms. <br /> Leff.1 006flamNium mdm1"uW will be$00 toy the tmk owner uAleft beg I ar2italimake& 1.FACILITY C3 2, PROPERTY OWNER 3.TANK OWNER 423 <br /> VR AITLICANT SIGNATURE <br /> C&AMOstill-TGvAfYfbxt*o idbusWoupemidodtovelain tram And mommuletu rho beg ofnWkuow1c4fx <br /> ±tK <br /> SIGNA OEAPPLXC,Wr DATE PHONE 10/16(03 ---7(916)635-24" <br /> ;NAW OF APP CANT(p&O A26 T=OF APPLICANT 427 <br /> '4 <br /> Amy C C- Dy Agent for Owncr <br /> 29 <br /> _U <br /> STA'T'E STFACri=NULMER(Finkwwo" 4 <br /> ) 1999 UPGRADE CEPTMCATF,NUMBER(Fartaw!«ao>tly) 4Z9 <br /> I Tpf-F 11199 relvicelu 171 Fnrmerlv 1RWRrFt'Fhrm A <br />