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ROM <br /> _ - ----- - <br /> �acility/Site --- ------ <br /> WEST LANE CHEVRON` <br /> 4747 WEST LN cERS CERSIDID43 <br /> STOCKTON,CA 95210 101813 <br /> Submittal Status <br /> Submitted on 12/18/2014 by RAVINDER SINGH of 5&A PETRO INC.(Stockton,CA) I <br /> Type of Action <br /> Transfer Permit <br /> Facility Information I Tank Operator <br /> WEST LANE CHEVRON' 'RAVINDER SINGH <br /> W747 WEST LN 209)992-1735 <br /> TOCKTON,CA 95210 14836 HARBOR CT <br /> acility Type Board of Equalization Account NumberLATHROP,CA 95330 <br /> Motor Vehicle Fueling 44042506 <br /> II �0facility located on Indian Reservation/Trus[lands7 - — <br /> NO, <br /> f <br /> rIN CR Owner anlcOwner <br /> RAVVINDER SINGH AVINDER SINGH <br /> 209)992 1735 209)992-1735 <br /> 14836 HARBOR CT L4836 HARBOR CT <br /> THROP,CA 95330 ATHROP,CA 95330 <br /> ank Owner Type <br /> __.._ on-Government <br /> 'Vermit Holder Information <br /> �c mit Holder Notification Information Supervisor of Division Section,or Office(Required for Pubic Agencies Only) <br /> itFacility Owner RAVINDER SINGH <br /> ' inagcialResponsibllityMechanism(s); _--- - <br /> ndic.te which approved mechanismis)are being used to show financial responsibility either as contained in the federal regulations 140 CFR,Part 280,Subpart H,Sections 280.93 through <br /> Bo"")or CCR,Title 23,Division 3,Chapter 18,Section 2808.1. <br /> elf-Insured Surety Bond State Fund and CFO Letter Other Mechanism <br /> Yes <br /> ...ante. Letter of Credit State Fund and CD <br /> ...once Exemption Local Government Mechanism <br /> Applicant Certification <br /> Appllcon' <br /> Na me Applicant Title Applicant Phone Date Certified <br /> (RAVINDER SINGH OWNER (209)992-1735 10/31/2013 <br /> Printed on 12/18/2014 4:30 PIA <br />