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08/26/2008 13: 04 7756234252 WINNEMUCCA TAX SERVE PAGE 02 <br /> i, <br /> UNIFIED PROGRAM CONSOLIDATED FO3!-[ <br /> UNIDERGR01JIV11 STORAGE TANK <br /> OPERATING PERM T APPLICATION-FACILIT 1' 'MORMATION <br /> 9 (One ram pct rwility) <br /> rYP2 OF ACTION I.NF.W PERMrr ❑ 5.CHANGE OF W-MMATION ❑7s 7,ERMANENI'FAC?tr Y CLOSURE e00 <br /> (Cht4`"man 081Y7 ❑ 3.RFNEWAI,P"mrf ❑ 6 1EPA"ARY FACr1.ITYCLOSURE Q 91 *ANS"PL'RMCr <br /> L FACILITY INFORMATION <br /> TO'I'Al-W)M"FR OF USTs AT FACILnY 'K FACRATY ID 0 <br /> (tel Use Gft sl <br /> w I� <br /> III 1$W-„SSNAME(S�uFuim%%wwl+m^-nowse,.+weA4 <br /> RI M INESS SITE ADORM <br /> I'AC'It_ITY l"YPF, i,MQTCIR vETrrCLE F(IFr.ItIG ❑ 2.r1JEl DISTRIH"Om f %ri*looted on hedim Rion or WL ros. <br /> ),FARM 4,PROCES” 6,OTHER hrWO ❑Yes allo <br /> 11. PROPM M OWNER INTVRMATI0 <br /> PROPERTY OWNFV NAME u �• aces <br /> MAILRNG AD <br /> _1_ s 8�-. (!//ri �►yry ' lva1 . i <br /> CITY Ora STAi7 ue. 'r,j"CODE •112. <br /> UI. TANK OPERATOR INFORMATIO` <br /> TANK OPERATOR NAME <br /> MAILING ADM§yres <br /> 17--§, IY'viemy or .t31tp(. <br /> CITY Jn4 STATE ' 'COUF. <br /> IV. TANK OWNER INFORMATION <br /> WANK OWNEWMF 414, R Z E els. <br /> _ .lo r/na��/ Lg f QJJ- S 6:;z-3- S2vp <br /> MARINO ADbR <br /> CITY 417, STA 4- ;1 'COUE •19. <br /> 1" � <br /> (vInn(ynvcc <br /> OWNER TYPE. ❑ 4.LOCAL AGENCYIDISTRICT ❑ 5.COUNTY AGENCY 1 Q 6-STATE AGFINCY .20. <br /> - — ❑ 7.FEDERAL AGENCY JK A-NOWOOVF-RWEW I L <br /> L V. BOARD OF EQUALIZATION 11"S I'ORAGE FEE AC-`;aUNT NUMBER <br /> TY }HQ 44 CaR the Sam Swed of Egeolizmeim' ',eI Tu Oi.Vxern,.t there arc quea+iam ''1. <br /> Vl.PBRMCT NOLD9R INFORMATION'k <br /> Issue pmnil and srnd leapl ootifi=iM MW naf"to' I.FACII,fiY OWNER ❑ 4.TANK OPERATOR az <br /> ❑ 3,TANK OWNER ❑ S.FACILOY OPERATOR <br /> r eae <br /> �SIipavISOR OC DIvtsm,SECTION.OR OFFICE(Requimd For Public AQm—0*) <br /> I!; <br /> VII.APPLICANT SIGNATURE <br /> CERT(F rCAIZPw: t nerd that dw iafiRa7tti�pro 1. <br /> hcrda b Rwe.■ucar■re,�+d r■FaR c f�aace wilti I aeremeatr <br /> APPL[CANT SIGNATURE DATE Pfi041E <br /> APPLICANT NAME fpr APM-rCA <br /> S ,>a Gq �cd►�ff <br /> UP(7F t)Vf,,A lie-.(I V2007) <br />