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T- <br /> UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANKS - FACILIT::I PTYPE OF ACTION r 1,NEW SITE PERMIT r 3.RENEWAL PERMIT IX5.CHANGE OF INFORMATION(Specify change- r 7.PERMAN <br /> (Check One item only) Baal use only) r S.TANK REMOVED-A00 <br /> F 4.AMENDED PERMIT <br /> r6.TEMPORARY SITE CLOSURE �{ � <br /> I.FACILITY I SITE INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or OBA-Doing Business As) 3 FACILITY ID R <br /> Fli ht Su ort Inc. A 0 0 . 1 7 7 <br /> NEAREST CROSS STREET 401 / qb([ S' JI___ FACILITY OWNER TYPE r4. LOCAL AGENCY/DISTRICT' <br /> Lindber h Street sOJ \ VOYrr� 1. CORPORATION I 5. COUNTYAGENCY <br /> BUSINESS TYPE r 1.GAS STATION r 3.FARM r S.FOMMERCIAL r 2. INDIVIDUAL <br /> C S. STATE AGENCY- <br /> r' 2.DISTRIBUTOR r 4 PROCESSOR r 6.OTHER r 3. PARTNERSHIP <br /> r 7. FEDERAL AGENCY- 402 <br /> 403 <br /> TOTAL NUMBER OF TANKS is facility on Indian Reservation or 'If owner of UST is a ouola agency:name of supemsor of <br /> REMAINING AT SITE eustlads9 dimsron,seCron«office whdr operates the UST <br /> v�+.. (This is Ne cbntaa person for the lank recoros.) <br /> 404 r Yes S'No *5 406 <br /> II.PROPERTY OWNER INFORMATION <br /> PROPERTY OWNER NAME 407 PHONE 408 <br /> San Joaquin Count 468 - 4700 <br /> MAILING OR STREET ADDRESS 409 <br /> 5000 S. Airport Way <br /> CITY 410 STATE 411 ZIP 00 412 <br /> Stockton CA 95206 <br /> PROPERTY OWNER TYPE r 2. INDIVIDUAL pr 4. LOCAL AGENCY I DISTRICT r 6. STATEAGENCY 413 <br /> R r 1 CORPORATION r 3. PARTNERSHIP 5. COUNTYAGENCY r 7. FEDERALAGENCY <br /> If.TANK OWNER INFORMATION <br /> TANK OWNER NAME 414 PHONE415 <br /> 982-1622 <br /> MOILING OR ST ET ADDR 416 Inc. <br /> 6164 s. Lindbergh St. <br /> CITY 417 STATE 418 ZIP CODE 419 <br /> Stockton CA 95206 <br /> TANK OWNER TYPE r 2. INDIVIDUAL r 4. LOCAL AGENCY I DISTRICT r 6. STATE AGENCY 420 <br /> IX1. CORPORATION r 3 PARTNERSHIP r 5. COUNTYAGENCY r 7. FEDERAL AGENCY <br /> TY(TK)HQ 4 1 4 I - 0 1 3 9 Call(916)322-9669 if questions arise 421 <br /> INDICATE METHOO(S) r 1. SELF-INSURED r 4. SURETY BOND r 7. STATE FUND r 10, LOCAL GOV=T MECHANISM <br /> F 2. GUARANTEE r S. LETTER OF CREDIT IXe. STATE FUND 8 CFO LETTER r 99. OTHER: <br /> r 3. INSURANCE r 5. EXEMPTION r 9. STATE FUND 8 CD 422 <br /> Check one box to indicate whim address should be used for legal notifications and mailing. A 1. FACILITY r 2. PROPERTY OWNER $ 3. TANK OWNER 423 <br /> L al not?dations and marlin s will be sent to the tank owner unless box t or 2 is onerkeb. <br /> Cendicaion: I certify that Me informatbn pr her m s true and accurate to Ne best of my knowkoge. <br /> SIGNATURE OF APPLICANT DATE 424 1 PHONE 425 <br /> I Mnrrh 9. 2002 982-1622 <br /> NAME OF APPLICANT(Print) 425 TITLE OF APPLICANT 427 <br /> Trent Brownlee General Manager <br /> STATE UST FACILITY NUMBER(Por local use only) 428 1998 UPGRADE CERTIFICATE NUMBER(Far focal use only) 429 <br /> J <br />