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BILLING
Environmental Health - Public
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EHD Program Facility Records by Street Name
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M
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MYRTLE
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2841
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2300 - Underground Storage Tank Program
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PR0505153
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BILLING
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Entry Properties
Last modified
1/2/2024 3:24:56 PM
Creation date
11/7/2018 8:18:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
RECORD_ID
PR0505153
PE
2381
FACILITY_ID
FA0006577
FACILITY_NAME
LABORERS UNION LOCAL #73*
STREET_NUMBER
2841
Direction
E
STREET_NAME
MYRTLE
STREET_TYPE
ST
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
2841 E MYRTLE ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MYRTLE\2841\PR0505153\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
10/25/2017 6:20:01 PM
QuestysRecordID
3699177
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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STATEDFOAIJFDCowiRoLeoARO CAt101A•FORMA • �,�,.ae�' <br /> TANKPERMIT APPU <br /> STATEWATERRE°.xO ISCfE ENily c1.osE0 sl <br /> RGROUNF <br /> DSTORAGE OREACNFA�Lm T PERMAN <br /> UNDE COMPLETETNIS FORM S CHANGE OF INFORMAT ON ❑ <br /> � TEAIppRARY SITE CLOSURE <br /> S RENEWAL PERMIT ❑ g <br /> Ifs` C q AMENDED PERMIT <br /> ❑ ' NEW PERMIT &ADDRESS (MUST BE COMPLETED) <br /> PERMIT ERATOR gNAD <br /> MARK 010 ❑ 4 INTERIMNppIEOFOP PAPCELeIOPI <br /> ONE REM TIGN STREET TMAREACODE <br /> IUTVISITE Iwo /I NEARESTC_ROSS Sim ONES <br /> 1. FAC F (Y1nP�a a O�RWLEY. <br /> pgpOR FAGILIN oAMI STATEY <br /> l� CA CD SLAM-AGO • <br /> / GOD glgy.AGE1KY• al <br /> ADOP SS . LOGA4AGENGV 1neUST D op I <br /> () KIP � DISTPIGTS gree 7SITE <br /> E.P.A. 1. .• tbn <br /> A CIN NAME �v AL CD FW Ed dNlebn,"don.of Otto nlch opal V if lNOWN B OF TANKS <br /> �gppM110N Q INDIVWG rvio�dtloNl <br /> d supe ❑ <br /> RESERVATIONDN ISECONDARI)'0P <br /> uh/I,^� ldethe lcllovdnB na11e OR IPUS7 LANDS MACE PERSO <br /> T NdCATE O enq•cort9 5 OTHER CV CO PHONE a WITH AREA LADE <br /> •It oNner d UST Ig aPubOc e9 p DISTRIBUTOR EMERGEN <br /> 1 GAS STATION CD A PROCESSOR T FIRST) 17H AREACADE <br /> OF BUSINESS O S FARM PNONEeW <br /> PRIMARY) DRYS:NAx JMrE(LAS <br /> AOT PERSON l WITIA E T FlPST1 <br /> EMERGENCY COPY pHONE Y N S. NAME IIAS ' <br /> E <br /> PAYS: <br /> NAME(U`ST.FIRST) PHONE 7,WITH ARE COD <br /> T FIRS INFORMATION <br /> NIGHTS:NAME l CARE OF ADDRESS Q L WAL.69",NCY �g' <br /> TION MUST BE COMPLET <br /> ED <br /> ,/OoxCkAkeU �IPAgiNERSMP EDFHONEe WITH AREAd <br /> R INFORMA CD <br /> 11. PROPERTY OWNE 0 GORPDPp90zIP GDDE <br /> NAME STATE <br /> MAILING ORS, <br /> ADDRESS <br /> CAPE OF ADDRESS INFORMATION <br /> CITY NAME T gE COMPLETED O LOCAL-AGENCY <br /> MATION IMUS ✓ Eoxb1t� CD INDIVIWAL Q ,0,jWV0 <br /> INFOR CD PpRTNEPSMP Ee <br /> 111. T ANK OWNER CD 01,poRAT ZIP CADS <br /> NAME OF OWNER STATE <br /> KESS g it questions arise• <br /> HARING OR STREET AOD Call t.916)322.966 <br /> l 31t� g ACCOUNT NUMBER <br /> CIN NAME UST STORAGE FE' ODtS) 1 <br /> OF EQUALIZATION ETED)_IDENTIFY THEMETH <br /> IV.BOARD DMPL D S INSURN CE <br /> K) FIQ 4 4' MUST BEO Y SUAppN EE ge OLNEP <br /> TV lT CIAL RESPONSIBILITY l O e E l RANEE <br /> UST FINAN k owner ur <br /> V, PETROLEUM OISEF.1NsuPED dbillin9willbesenitothelan <br /> O 5 LE7rEPOF CREdT <br /> bIt Leg Ii noUlicalio Fr AND BILLING, <br /> pNp BILLING ADDRESS TIF CATIONS AN KNOWLEDGE, <br /> i <br /> NOTIFICATION gE USED FORLEGAL NO BEST OF�,� <br /> VI. LEGALUFY AND TO THE <br /> VE SSS WHICH ABO PERJ <br /> KINDICATING ED UNDER PENALTY <br /> OF <br /> CHECK ONEW COMP <br /> OWNER'STRLE <br /> THIS FORM HAS BEEN <br /> PRI <br /> MEpg SIGNED) , <br /> OWNER'SNAM E L <br /> ONLY JURISID-TON <br /> J� N <br /> LOCALAGENCY USE IJ <br /> TRICT CODE• 3 d3 <br /> COUctaMGp.as <br /> -OPT 3,UNLES <br /> CENSUS TRPCT>t ATW►I'FORM <br /> OPTIONAL TOR MOREPERMIT APP LIC �INOTNEUNDERGRO <br /> LOCATION CARE - <br /> MPpN1ED BV AT LEASt l TME LORAL AGENCY IMPLF <br /> T BEAM FI�THISFORMW� <br /> THISFORMM MUST tp _{-,_ ,� <br /> FORM A(SreSI L� <br /> j r- srsl 7 <br />
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