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0 0 <br /> MAY-19-2)09 II:27AM FROM-TRANS SYSTEM 509 625 3967 7-082 P.001/001 F-631 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGETANK <br /> OPERATING PERMIT APPLICATION—FACILITY INFORMATION <br /> (One(otm per facilityl <br /> TYPE OFACTION ❑ 1.NEW PERMIT ❑ 5.CHANGE OF INFORMATION ❑ 7.PERMANENT FACILIl'Y CLOSURE <br /> (Chrek nne imm only) JX 3.RENEWAL PERMIT ❑ E,TEMPORARY FACILITY CLOSURE ❑ 9.TRANSFER PERMIT <br /> I. FACILITY INFORMATION <br /> TOTA L NUMB OF USTs A'F FACILITY 4U4' FACILITY ID n _ _ TTTT <br /> �• <br /> (Ageagy Use Only) <br /> BUST ESS NAME(5mmm,FACILITY NAME or DDA lin,,Dmin, Aij 1, <br /> TSI TRANS-SYSTEM INC <br /> RUSD ESS SITE ADDRESS ma. CITY uu. <br /> 707 E. ROTH RD FRENCH CAMP <br /> FACT TV TYPE (]T MOTOR VEHICLE FUELING ❑ ?.FUEL DISTRIBUTION io7' lc the Ftcility leeawd on Indian Reservation or 40 <br /> ❑ 3.1 RM ❑ 4.PROCESSOR 0 6,OTHER Tncn IDnds? ❑Yea [„XNo <br /> II. PROPERTY OWNER INFORMATION <br /> PROP]RTY OWNER NAME Oat, PHONE Na. <br /> TSI TRANS-SYSTEM, INC <br /> 800 <br /> MAIL GADDRESs 541-4213 +na. <br /> 7405 S. HAYFORD RD <br /> CITY +tu STATE 43 I. ZIP CODE <br /> +r. <br /> CHENEY WA 99004 <br /> III. TANK OPERATOR INFORMATION <br /> TANK OPERATOR NAME +=a-I PHONE <br /> TSI TRANS-SYSTEM INC ( 800 ) 541-4213 <br /> MAILI 40ADDRESS +s-) <br /> 7405 S. HAYFORD RD <br /> CITY +:k-+ STATE +vo-s ZIP CODE +aFs <br /> CHENEY WA <br /> 4 <br /> IV. TANK OWNER INFORMATION <br /> TANK WNERNAME +14. PHOND- as. <br /> TS1 TRANS-SYSTEM, INC ( 800 ) 541-4213 <br /> MAILI GADDRESS +in, <br /> 7405 S. HAYFORD RD <br /> CITY W. STATEZIP am. <br /> CHENEY WA 04 <br /> OWN& TYPE: ❑ 4.LOCAL AGENCY/DISTRICT ❑ S,COUNTY AGENCY ❑ 6,STATE AGENCY 420• <br /> ❑ 7,FEDERAL AGENCY Q'R,NON-GOVERNMENT <br /> V. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> 1_y_(T )H2 44- 10 F-1 C4II the Slate Board ofEgWkWlion,Fuel Tax DivlRion,if them auto 9lue'6011c. 431' <br /> VI.PERMIT HOLDER INFORMATION <br /> Issuo mil and send legal notifications and mailing'to: I.FACILITY OWNER 4''' <br /> P g L.s � ❑ 4.TANK OPERATOR <br /> ❑ 3.1-ANK OWNER ❑ S,FACILITY OPERATOR <br /> SUPER VISOR OF DIVISION,SECTION,OR OFFICE IR uimd For Public AD, <br /> M Agencies Only) <br /> VII,APPLICANT SIGNATURE <br /> CERT 1CATIp 1acopdfvat[ nformnEidn rovided hcrcin is true,accurate,and in full emu Mance with legal re uiremuntti. <br /> APPL DATE +'+ PHONE +:5 <br /> 5/19/2009 509 623-4037 <br /> MP I ANT NAM" ring +�a APPLICANT TITLE +:7 <br /> STEVEN RAY TUCKER REGULATORY COMPLIANCE MANAGER <br /> VPCs I ST-A Row(It1O" <br />