Laserfiche WebLink
1,A/11/2 0 0 4 1 '47 "-4n 1 UO2 1) <br /> VNIFIE;PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> OPERATING PERMIT APPLICATION—FACILITY INFORMATION <br /> (One form per facility) <br /> VYPE OF ACnOX [1 1,NEW PERMIT 5 CHANGE OF WOW- AnON7 PEk-'4A*.%'EWPACT!rrYCL0SVRC <br /> 3 RENEWAL PFR [1 6 TEMPORARY FACILITY CLOSURE C] q.TAA.NSfER' <br /> PUNIT <br /> I- FACILITY MORMATION <br /> 'ICTALNU ER FUSnATFACILfTY' 404, ('4$VnVY Via OWY) T77-7 <br /> FACILITY ID <br /> ICTAL <br /> "U E' F <br /> N'5 P <br /> Bra.S <br /> N AME a ar Fa af 1gy,—'V4—M 1-1—.- --—D.I <br /> �oy <br /> cy 6. Reliance Gasp Investments, In8J5A <br /> SITE Al)tl <br /> V <br /> SUSINF-�$SrrB ADDF <br /> W. <br /> Gran tfs 'w Cr'Y <br /> i� � G n Iti TMC' <br /> r Crry <br /> 2420 V t ne Road Tracy <br /> F ru _YFE E I f <br /> ACN�77YTYFE 1,MOTOR VE19CLE FUELING 0 1.FUEL DISTRIBUTION lsh, "'17 <br /> 3 f -d <br /> Is the facility IomW on in i"Rojor-yujoy, <br /> 3.FARIM C2 4�PROCESSOR 0 6 Q7HER Trusi.lands? C L 2.No <br /> EL PROPERTY OWNER LNrFORMATION <br /> NE <br /> Rod I ostee <br /> 209 ) 835-4629 <br /> ............ <br /> 2460 Tastes Road <br /> CITY <br /> L Tracy STATE 471. ZjpC UE 411. <br /> CA 95377 <br /> M. TANIK OPERATOR INTORMATION <br /> E <br /> .Arop <br /> OF i' - <br /> rTA NX OPERATOR NA <br /> Reliance Gas Investments, Inc. <br /> -7445 <br /> NML—R�40ADDR,ESS <br /> 2420 <br /> �420W. Grantline Road <br /> Ury <br /> 42A7-, STATE 197TYjTZME <br /> Tracy <br /> CA 95377 <br /> TANK VWNFR NA NG IV. TANK OWNER INFORMATION <br /> 414. ' PHONE 41S. <br /> Reliance Gas Investments, Inc. 1 (209 )481-791.45, <br /> MKILINGAJ)DRES <br /> 2420 W. Grantline Road <br /> CITY— 417. STATE 411 <br /> I ZIVCODE ,79 <br /> Tracy <br /> CA 95377 <br /> OWNER TYPE: [3 4.LOCAL AGENCYIDISTRICT El S.COUNTY AGENCY 0 6,STATE AGENCY <br /> El 7.FEDERAL AOLNICY 9 8,N0N-GQVCIQ;.WNT <br /> V.. BOARD OF EQ–TJALIZATION UST STORAGE FEE ACCOUNT NUMBER <br /> CGI{the State 90trd Of UluMimtioc,Fucl Tax Di'i'630n'if M 0 quenotIs Isl <br /> -Alv� the111,11 <br /> PERMIT"Hi O-LDER INFORMA77ON <br /> f If I — --- <br /> tsuc permit and 3ead[cpl notifimtiorls ud rrwj�np to; ❑ I.FACILITY OWNER 0 4.TANK OPER&,rOR <br /> IR 3,TANK 01AINER 0 5JACILITY0 BRATOR <br /> —OR OFF'Cr in-11111111dl- <br /> PLICANT SIGNATURE I <br /> �JFCA <br /> �CCERTIFI ATION! Tcvfi*the vide <br /> r ide <br /> APPLICANT SIGNATURE— lftjg�rue,arcu,mie,and in full cum"Ince with lleg rcQVIIEmM—Oylts <br /> P14ONE <br /> APPLICANT NAME(prim) 4.17 <br /> ILA 0 <br /> C" J <br /> IJPCr US7-A Rev.(12rv007)-1/2 www.uuidoc&*rj <br />