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UNI IED PROGRAM CONSOLIDATED FORM <br /> f � TAN <br /> ' UNDERGROUND STORAGE TANKS - FACILITY <br /> (one pabEper sd <br /> Paye '0 of <br /> TYPE OF ACTION [- I.NEW SITE PERMIT F 3.RENEWAL PERMIT 1X5,CHANGE OF INFORMATION(Specty,change- F 7.PERMANENTLY�OSED;SIT�'„ <br /> (Check one item only) F' 4."ENDED PERMIT local use only) r B.TANK REMOVED`-.'�00 <br /> r S.TEMPORARY SITE CLOSURE <br /> I.FACILITY I SITE INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA.Doing Business As) 3 FACILITY 10 x <br /> Fli ht Su ort Inc. A .,� 0 0 - --° 7 7 <br /> NEAREST CROSS STREET 1 \'LQ -ACILITY OWNER TYPE <br /> r 4. LOCAL AGENCVIOISTRICT- <br /> Lindber h Street 1. CORPORATION r 5. COUNTYAGENCY• <br /> BUSINESS TYPE r 1.GAS STATION r 3.FARM , 5.COMMERCIAL r Z. INDNIOUAL F B. STATE AGENCY- <br /> r' 2.DISTRIBUTOR r 4.PROCESSOR r 6.OTHER r 3. PARTNERSHIP r 7. FEDERAL AGENCY' 402 <br /> 403 <br /> TOTAL NUMBER OF TANKS Is facility on Indian Reservation or 'if owner of UST is a wolic agency.name of sucerrisor of <br /> REMAINING AT SITE maiden"? division,enchant or office which operates the UST. <br /> Tt (This is the ranted:Person for the tank records.) <br /> 404 FY. i'No 405 106 I <br /> Il.PROPERTY OWNER INFORMATION <br /> PHONE 408 <br /> PROPERTY OWNER NAME 407 <br /> n Joa uin Canty <br /> ount 468 - 4700 <br /> MAILING OR STREETAODRESS 409 <br /> 5000 S. Airport Way TATE 411 ZIP CODE 412 <br /> Cm am <br /> n <br /> CA 95206 <br /> TY OWNER TYPE <br /> PROPERF 2. INDNIDVAL ppr 4. LOCAL AGENCY/DISTRICT -r 6. STATE AGENCY 413 <br /> K r 1. CORPORATION F 3. PARTNERSHIP a. COUNTY AGENCY r 7. FEDERALAGENCY <br /> - ill.TANK OWNER INFORMATION <br /> TANK OWNER NAME 414 _ PHONE 415 <br /> 982-1622 <br /> MAILING ORS ET AOOREPr 410 <br /> Lindbergh St. <br /> CITY 41] STATE 418 ZIP CODE ckton 419 <br /> CA 95206 <br /> TANK OWNER TYPE r 2. INDNIDUAL r 4. LOCAL AGENCY I DISTRICT r 6. STATEAGENCY 420 <br /> 1X1. CORPORATION [ 3. PARTNERSHIP r 5. COUNTYAGENCY r 7. FEDERALAGENCY <br /> TY(TK)HO 4 4 - 0 1 3 9 Call(916)322-%69 if questions arise 421 <br /> INDICATE METHODS) r 1. SELF-INSURED F 4. SURETY BOND F 7. STATE FUND r 10. LOCAL GOV-T MECHANISM <br /> r 2. GUARANTEE F S. LETTER OF CREDIT 1X8. STATE FUND 8 CFO LETTER r 99. OTHER <br /> F 3. INSURANCE r 6. EXEMPTION r 9. STATE FUND 8 CO 422 <br /> Cheri ane box to indicate which address she used for legal notifications and mailing. 1. FACILITY r 2. PROPERTY OWNER % 3. TANK OWNER 423 <br /> outs b <br /> led 1 t! and mallims willD sent to the tank owner unless box 1 or 2'is cnsch d <br /> V11 APPI;rANTRIrNATIIRF: <br /> Centcation: I deary,that Ne inlormatbn pr h m as INe and accurate to Ne best of my knowleoge. <br /> SIGNATURE OF APPLICANT DATE - - 424 PHONE -425 <br /> Mnrch 8. 2002 982-1622 <br /> NAME OF APPLICANT(pant) 425 TITLE OF APPLICANT 427 <br /> Trent Brownlee General Manaizer <br /> STgTE UST FACILITY NUMBER(For local use only) 425 1998 UPGRADE CERTIFICATE NUMBER(Forkk:a/use only) 429 <br />