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IFIED PROGRAM CONSOLIDATED FOR PR#:PR0232461 FAC#:FA0003758 UNDERGROUND STORAGE TANKS -FACILITY / a (ane page per site) \\ TYPE OF ACTION ❑ LNEW SITE PERMIT ❑ 3.RENEWAL PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 7.PERMANENTLY CLOS ❑ ❑ FrP1TY��l� '6 (Check one item only) 4,AMENDED PERMIT 8,TANK REMOVED ❑6.TEMPORARY SITE CLOSURE Oro I.FACILITY/SITE INFORMATION 3633 DUCK CREEK DR.STOCKTON BUSINESS NAME issue ar FACB,RYNAME er DBA-Ming Burmear As) 3 FACILITY ID# PR ID# RYDER TRUCK* FA0003758 PRO232461 d NEAREST CROSS STREET FACILITY OWNER TYPE ❑ 4,LOCAL AGENCY/DISTRICT' DUCK CREEK 401 ❑ 1.CORPORATION ❑ 5.COUNTY AGENCY' BUSINESS ❑ I.GAS STATION ❑ 3.FARM ❑ 5.COMMERCIAL ❑ 2.INDIVIDUAL ❑ 6.STATE AGENCY' TYPE ❑ El 3.PARTNERSHIP 402 2.DISTRIBUTOR 4.PROCESSOR ❑ 6.OTHER 403 ❑ 7.FEDERAL AGENCY' TOTAL NUMBER OFTANKS Is facility on Indian Reservation or *If owner of UST is a public agency:name ofsupervisor of division,section or office which operates REMAINING AT SITE tlustlands? the UST(This is the contact person for the tank records.) 404 ❑ Yes ® No 405 RYDER TRUCK 406 II.PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 407 PHONE Ops 916 631-7933 MA UNG OR STREET ADDRESS 409 3633 DUCK CREEK DR CITY 410 STATE 411 ZIP CODE 412 STOCKTON CA 95215 PROPERTY OWNER TYPE ® 1,CORPORATION ❑ 2.INDIVIDUAL ❑ 4.LOCAL AGENCY/DISTRICT ❑ 6.STATE AGENCY ❑3.PARTNERSHIP ❑ 5.COUNTY AGENCY ❑ 7.FEDERAL AGENCY 413 III.TANK OWNER INFORMATION TANKOWNERNAME 414 PHONE 415 RYDER TRUCK 916 631-7933 MAILING OR STREET ADDRESS 416 3633 DUCK CREEK DR CITY 417 STATE 418 ZIP CODE 419 STOCKTON CA 95215 TANK OWNER TYPE ❑X 1.CORPORATION ❑ 2.INDIVIDUAL ❑ 4.LOCAL AGENCY/DISTRICT ❑ 6.STATE AGENCY 420 ❑ 3.PARTNERSHIP ❑ 5.COUNTY AGENCY ❑ 7.FEDERAL AGENCY IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY(TK)HQ 44- 1 Call(916)322-9669 if questions arise 421 V.PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(s) ❑ 1,SELF-INSURED ❑4.SURETY BOND ❑ 7.STATE FUND ❑ 10.LOCAL GOVT MECHANISM ❑2.GUARANTEE ❑5.LETTER OF CREDIT ❑ 8.STATE FUND&CFO LETTER ❑ 99.OTHER El 3.INSURANCE ❑6.EXEMPTION ❑ 9.STATE FUND&CD 422 VI.LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. ® L FACILITY ❑ 2.PROPERTY OWNER ❑3.TANK OWNER 423 Legal notifications and mailing will be sent to the tank owner unless box 1 or 2 is checked. VII.APPLICANT SIGNATURE Certification-I certify that the information provided berein is true and accurate to the best ofmy knowledge. SIGNATURE OF APPLICANT DATE 424 PHONE 4B NAME OF APPLICANT(print) 426 TITLE OF APPLICANT 427 STATE UST FACILITY NUMBER(For loud oe oruy) 428 1998 UPGRADE CERTIFICATE NUMBER(Far hood me only) 429 Is 1998 Compliant?Y UPCF(1/99 revised)