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IED PROGRAM CONSOLIDATED FOFq TANKS UNDERGROUND STORAGE TANKS - FACILITY (one page per site) Page I of .3 TYPE OF ACTION ❑ 1.NEW SITE PERMIT ❑3.RENEWAL PERMIT ®57ANGE OF INFORMATION ❑ 7.PERMANENTLY CLOSED SITE (Check one item only) ❑4.AMENDED PERMIT specify change local use only ❑ 8.TANK REMOVED ❑63EMPORARY SITE CLOSURE 400 1.1FACILITY/ tiRMATI BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FAG! Pacific Bell Telephone Company dba AT&T California ' NEAREST CROSS STREET 401 FACILITY OWNER TYPE 0 4.LOCAL GENCWDISTRICT* 2ND STREET AT&T(UG010) ® 1.CORPORATION ❑5.COUNTY AGENCY* BUSINESS L1 1.GAS STATION 3.FARM 129 5. COMMERCIAL ❑ 2.INDIVIDUAL ❑6.STATE AGENCY* TYPE ❑2.DISTRIBUTOR ❑4.PROCESSOR❑6. OTHER 403 ❑ 3.PARTNERSHIP ❑7.FEDERAL AGENCY* 402 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST is a public agency:name of supervisor of division,section or office REMAINING AT SITE trustlands? which operates the UST(This is the contact person for the tank records.) 1 404 ❑ Yes ® No 405 1 406 II. PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407 PHONE aoe Pacific Bell Telephone Company dba AT&T California 214-464-1929 MAILING OR STREET ADDRESS 409 2600 Camino Ramon, Room 3E000 CITY 410 1 STATE 411 1 ZIP CODE 412 San Ramon CA 94583 PROPERTY OWNER TYPE 0 1.CORPORATION 2.INDIVIDUAL 4.LOCAL AGENCY/DISTRICT Ll 6.STATE AGENCY ❑3.PARTNERSHIP [15.COUNTY AGENCY [17.FEDERAL AGENCY 413 111.TANK OWNER INFORMATION TANK OWNER NAME 414 PHONE 416 Pacific Bell Telephone Company dba AT&T California 214-464-1929 MAILING OR STREET ADDRESS 416 2600 Camino Ramon, Room 3E000 CITY 417 STATE 418 ZIP CODE 419 San Ramon CA 94583 TANK OWNER TYPE 0 1.CORPORATION 2.INDIVIDUAL 4.LOCAL AGENCY/DISTRICT 6.STATE AGENCY 420 ❑3.PARTNERSHIP ❑5.COUNTY AGENCY [17.FEDERAL AGENCY IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 1 0 13 11 19 1 1 4 1 Call 916 322-9669 if questions arise 421 V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE [11.SELF-INSURED [14.SURETY BOND [17.STATE FUND [110.LOCAL GOVT MECHANISM METHOD(s) ❑2.GUARANTEE [15.LETTER OF CREDIT ❑8.STATE FUND&CFO LETTER ❑ 99.OTHER: ®3.INSURANCE ❑6.EXEMPTION 9.STATE FUND&CD 422 VI.LEGAL.NOTIFICATION D MAILING ADDRESS Check one box to Indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 Is checked. ❑ 1.FACILITY ❑2. PROPERTY OWNER ®3.TANK OWNER 423 VII.APPLICANT SIGNATURE Certification-I certify that the Information provided herein Is true and accurate to the best of my knowledge. IGNATURE OF APPLICANT DATE 424 1 PHONE 425 9/26/2007 (214)464-3131 N E OF APPLICANT(print) 428 TITLE OF APPLICANT 427 Ja on D.Weller Manager, EH&S STATE UST FACILITY NUMBER(For local use only) 428 1998 UPGRADE CERTIFICATE NUMBER(For local use only) 429 San Joaquin Counly. OFS UPCF(1/99 revised) Formerly SWRCB Form A