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Mar-12-03 05:31p W[> - -ey Oil , Inc. <br /> 248 0755 P- O2 <br /> UNIFIED PROGRAM CONSOLIDATEb FORM I -� <br /> l'UNDERGROUND STORAGE TANKS - FACILITY � <br /> hBll TANKSI'1'1'L OI' At"Ile,] Pec page per cite) Page, 9f <br /> ❑ 7 N[\cs ll.I'h.IP,111 ❑ i kt:\EWAJ.I'1!kl.il <br /> (('hrcknncncmnnhj ❑a,:NlliRI)ho Pk3R1,R7 LJ <br /> %t'1.I21:.lVh\"1'IR('LOSIiU SI'rF. <br /> speei[p change local uv<•nnly ❑ < "Ri; IJTtwpu) <br /> -- -__-- _ ❑o'IT\1PORAI(1'SI'[I•:('I OgLI2Ii <br /> 1. FACILITY/SITE INFORMATION <br /> 111 .IN,SS'11lIF rveae uan l e,"\n4l wn Iwdnp n,:i nue,\.at ) 1 \C 11.1'I'}'ID( <br /> Vallev Pacific Petroleum Sen-i.:es lnc _Rapid)\ash 1 I <br /> Ne1Rr.s'rcaoxlrxr:I r — -- _ I - <br /> Ca nler Rand <br /> 36y t7 S. }iW Y q� al I. <br /> COamv"'F. 7l Pb ❑, aOENCY DISTRICT* <br /> 13cs[N- 1.<lns s�rA'r1<is C]i P:\RM1I ® 1.cOxroRA'rtON ❑5.COI;\n'AGENCY- <br /> ® . c mI\uikcl:u• ❑ 2 INDI1a D( AI. <br /> TIP} 02 DISTRIHI-I'OR ❑4 PROCtSSOR ❑e 11117, \GFNCT" <br /> _ ❑(. O,,mu) wi ❑ l P IRT\I'x1H'P [] 1 I DI It:11 1(iF.\CYs <br /> [(JIV KIb[HIk UI T�\NAI -_- Is(.-6111V-un Indian kcse,rra)ion ur - *R ner ,f'I FI t. puhl s8cnc.lnm taq. Mli <br /> RLILVNING A'1 SITE tm(IanJc'! apr.rat the I1ST(Thic ie the umtutt pusmlr lint nAn r,l.tm.veanm or uc<whieh <br /> 2 - -.. - u" ❑ Y4, ® No ws <br /> IL PROPERTY OWNER INFORMATION <br /> PROPERTI'OR'NtR N.\M1IP --.__— <br /> . ftl' PTIONE <br /> Ra IdwashJnc _ <br /> M11AILIN(i Ox S1 {209)903-()i9:T <br /> 3550 S. Hi hwaY <br /> .------- <br /> no zu'CODL. --- -- <br /> Stockton n, <br /> CA_ 95205 <br /> ❑ <br /> PROPt:k11"ON'N t:N'I'1'Ph ® 1 Cf)k l'OH.1110N ❑,2.INU11'ID[�AI. — --- ---- <br /> 4.LOC:11.AO}:NC'}''DISTRICr ❑U S'I':\I F'aGIfNC}' <br /> --.-- ❑.I.PARTNERSHIP 0.CO('N1i14NCT ❑7 1 P:0I`R:11.A(rt:SC'1' <br /> Va <br /> RI. TANK OWNER INFORMATION <br /> Valley Pacific Pelrolellll) SCI-vices. Inc un <br /> (209)949-9411 <br /> NIAITANGORSTRI(PY:\DORI!SS—-- <br /> 100 Frank West Circle <br /> u- s'rn'rE— ua zu'coDls __ <br /> Stockton r <br /> CA 95200 - .. <br /> T:\NK ON'S}R 1'TI'Ii � LC'GRI'Ox CI'fON 2.INDIb"IIA7\l. 4 LOCAL,Ail NCI -T)-IRIC•I' <br /> axo <br /> ❑3.PARTNER Sill], ❑5,COU\'ll• 1GtNC'1' ❑'.I1'DER 11.AUENCY <br /> IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> TY(TK)HQ 44-=T--- -- _— <br /> .�--.-I-_--1 ' —_.._ .__._ Call(')16)322-t)Gli9ifqucslionsanx' ul <br /> V. PETROLEUM LIST FINANCIAL RESPONSIBILITY <br /> INDIc.aTE NrP;rnul> > p 1 sra r-INS( Izr•.n ❑4.Sukr:n•HUN) ❑7 STXI'J;RTm) -- — <br /> ❑ I0.IJ7C.V.GON"I'MECIIANISN1 <br /> ❑z cl :vi.\\rI':E ❑5.1ACI'r4;R O LAO DIT ®8.SIAIT 1'I"N'D&CPO I.H I'TI+R ❑ 99 (frllhR" <br /> ❑ 1INSUR\\C'}: ❑6.r;XEMP'r[ON ❑9.51 \rrrt"D&CI) <br /> 122 <br /> VI. LEGAL NOTIFICATION AND MAILING ADDRESS <br /> ChccA nno hmminde lc which nlJt .:h IJ Pe uIr rl El nnl hent. stwl m.uling -" - <br /> L.gnl no)ifcnt-m mJ mnilmgs,ttl M n tb,c rnk wnu unksnh l,n'mehecAcJ ❑ I I'M I.T'I') -\`--- <br /> ❑2 PARI°EAT) P.R'.L1: ®.. L\S6 U0.'SER PJ <br /> VII.APPLICANT SIGNATURE <br /> ------- -------- <br /> (.rtificnuov I ..--------- <br /> unl;that the nl' nl pr„ J.J hrr,n utrve:mJ uaur:ue to the hcl N qY>; - - ___._....-_._ <br /> - nd Jyc. <br /> SIGNAT'L ' OI \ I.IC•,\N1 ---_-- U;\7F iat 1 <br /> 31fr I -q �yiz <br /> Nn11r.OPnPILR \\r(pnn(1 i' TIT•Iri)t \i'P )c:1)''r _- zo1)-- r, <br /> f1��2 EI/atnn Crt c�103 Nca we t� <br /> S'1';V'RI:S'1'1AC'll.l'fY\'I'.11nr:k:r�rl.,:,l u..,nnrv' till 1998 UPGR:1llf>CERTIPIL'A'1'E NIIV 04.11,-..,I,.,.,'. .< •m)�1 ,12 <br />