Laserfiche WebLink
�I. STATEOF=FORMA <br /> STA-M WATER RESOURCES CONTROL BOARD y; <br /> UNDERGROUND STORAGE TANK PERMIT APPLICATION FORM A <br /> C--MPL-=7"E THIS FORM FOR EACH FAGLfiY(S1TE <br /> NEN PERMIT AL. ENAL PSRMIT I S CXAN.Cc OF WFCPMA'AN U 7 PE:NANEVTLY CL 5w�,,SITE 1 <br /> MARK ONLY > AMENCEO PERMIT C S TEMPORARY SITE. CLCSURE YAW- <br /> ONE ITEM 2 INTERIM PERMIT <br /> L FACILITY:SiTE INFORMATION 3 ADDRESS.(MUST BE COMPLETED)�MsoG.PE.^> oR �s <br /> DB>ORFAZ NAME POSDEF Power Company, L.P. r,'SAN.10 <br /> POSDEF Power Company, L.P. 0• l .v <br /> NEARES-CROSS SIRE I vwc'_L.�(.' r - iF� _r <br /> ACCRFSS W. Washington St. <br /> 2526 W Washin ton Street ISTAT< aP C.^CE Islr PNCNEawiTH AREA CE <br /> CITYNAME CA I 95203 209)467-3838 <br /> Stockton <br /> PARTME75'AP G LOCAL-K-NC" �I eouMY-+GENU! !_ sr>rE.-aGEVCY <br /> J BOF Po7ERdL>GENLY <br /> M INnoA5e `eoRxPAncx Cllrnmoua Cir' o6;ae-s <br /> C J 'F!NCIAN •G'TANK$AT SRE E.P.A L D.t iaPNP'Idl <br /> TYPE OF aus:-%Sss I GAS STATION C 2 DISTRIBUTOR SEE AVATICN <br /> F-7 S FARM C • PRCCaaSCR S CT'riER I CR CRCST'1NCS I 22 <br /> VAERGE-.1CY CONTACT PE?SON (PRIMARY) E'AERGE9CY CONTACT?E3Sv^N (SECONDARY)-optional <br /> OAVS: NAME it>57.GiR58 PFCNE a'MTN AREA GCE GAYS:NY>E d?sT.---- (209)467-3838 <br /> rfl (209)467-3838 Tavlor, Kv1e e..^• -� F ^^^_ <br /> NIGwTS: W.NE;LAS T.Gin51 P4CNE a'NITd AF'cA wCE NIGn:S: N>NE.LAST.PI'nSTI (209)474-3794 <br /> - � (209)334-1602 I Taylor, Kyle RY^Ncawm+AF=+^^^n. <br /> II. PROPERTY OWNER INFORMATION-(MUSTEECOMPLETEDI ,•SnE.,-FAODRES-'.NFCRNA'CN <br /> NAME I ^ ^^ <br /> Port of Stockton J b[aua""•" !_ :NONICUAL = LCC.::ia2hcY p $TAT-E.-AG<;NCY <br /> MAILINGCRSTA- •ACCRESa I CPxM w.N �; � Ev1l-AGENCY <br /> 2201 W. Washington St. <br /> CRY NAME IST>a Z'P CCCE 1 PNCNE a':!I i F AREA C.^.CE <br /> S'rockton CA 1 95201 I (209)946-0246 <br /> III. TANK OWNER INFORMATION-(MUST BE COMPLETED) <br /> NAME CG r, ASE CF:OCBEB$ NGCRM4�CN <br /> ` <br /> POSDEFN:[ER Power Company,_L.P. I _ AGENCY <br /> M>IL:NG CF STREB->CCRESS 'I _J b[ANFiJ :_ .NCNCuB LOCA4:GEVCY <br /> 2526 W. Washington St -_oc:ra:-CN ! iM:TN'r.5Hi7 COUNTY.•^.NC-! iiF�E;AL+IG-eNCY <br /> i37A= u7 CCCF P!CNE a NIT. ARE>=E=.. NAME n <br /> Stockton CA 9F.2.3 I (209)467-3838 <br /> IV.BOAR0 OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER-Call;.9 16)323_Scc li CCE-sons ansa. <br /> TY(TK) HO �-'10 1 3 14 1 617 18 1 - <br /> V. PE-,RCLEUM UST FINANCIAL RESPONSIBILITY-(MUST SE COMPL-ED)-IDEVTIRf THE METHOD(SI USED <br /> I SE.L�NSJR'eO L.!2 GUAG:NrBB �` :HSUGANCE a jUBC/BOND <br /> J ba Piw:a r— 8�E T^ — n O•*i <br /> L 5 R CG ED!T <br /> VI. LEGAL NOTIFICATION AND BILLING ADDRESS Lea_al notification and billing wlil be sent to the tank owner unless'-ox I or II is checked. <br /> CNE.7A <br /> ONE BOX INCICATING WHICH ABOVE AOORESS SFICULO B-E.USED FOR LEGAL NCnF'CA CNS ANO BILLNG L I <br /> 11.7-1 <br /> THIS FORM HAS SEcN COMPL57ED UNDER PENALTY OF PE:RJUPY•AND TO 7iiE SES7 OF MY KNOWL7GE.IS TRUE AND.CORREC7 <br /> APPL:CAN,is N>ME a9L¢`+A 11( APPOCANTS TITL OAT-E. MCNTWOAYNGAR <br /> Richard :+. Recor , <br /> General Mana4er 10/2/92 <br /> LOCAL AGENCY USE ONLY <br /> COs JURISL_L_L_ s FACILITY s <br /> I IZ5 ] IDZ��2 <br /> LOc>TIONQOF�-PPn0ML ICuVSUs TART. Yf7Pj,ONAL :suPvlso O3� 4'.-COOE -CP nONAL <br /> 17 <br /> THIS FORM MUST BE ACCOMPANIED BY AT LEAST(T)OR MORE PERw APPLICATION- FORM B,UNLESS THIS IS A CHANGE OF SRE INFORMATION O s <br /> FORM Ab9q �� <br />