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01/26/00 17:15 FA% 707 693 2922 W A CRAIG INC 02 <br /> STATE of cAurOANLA <br /> STATE WATER RESOURCES CONTROL BOARD F �' <br /> UNDERGROUND STORAGE TANK PERMIT APPLICATION-FOI I U A <br /> COMPLEfETHIS FORM FOR UMFACRF1115n <br /> NARK ONLY ® T NEW MUST p 2 FIENEAAL FERATT O 0 CHANGE OF INFORMATION I_] T P9NwNENTLY aoeEO 9OE <br /> ONE REM p 2 XTETKA PEW Q A AMENDED PE-UT Q 5 TFAxAIRMT/ GRE CLQKUTTE <br /> 1. FACILRYISITE INFORMATION A ADDRESS-(MIST BE COMPLETED) <br /> NxAORFAKxItFYnMATE � NAIAEOFWQUTiOR <br /> RAP-Soo - E L ate P <br /> ACORESSj� NEAAMCRDSSSTREET "xa-N(� 1 <br /> (� V5- NAG ' C Au QnvG S'T- <br /> OMfNAME STATE I NP CCOE 9R'E PROVE PVYRN AF�AOGLE <br /> 5i ornkTOO CA 94506 /vA <br /> ✓IIDx C]curam N p mxVmIR 0 Pmwwom TY L:j LDIiKIAGE" 0 GOURY-A000Y- E:I ITAUAGEN6Y' 0FMEVLA2DCY <br /> 700CMIE DSTRM <br /> m.dKSTY°pok . , raacArbbsaN mmdNPpolpdWYble°tlkAadbYeueprbubl$T <br /> TYPE OF BUSINESS 160.5 STATION 2MmpUIPR ✓IF INCLAN SOF TANA9 A79YfE E/n�P.A. LOi(4:ari <br /> SFAM © aPROCESSOR p 2OREA ORT TW s <br /> EMERGENCY CONTACT PERSON ((ARIL IM EMERGENCYCONTACTPEM:N IeEcoaDARYI-opNanal <br /> DAYS: (LAST.FIi4Tl PHONE 410THAREACCDE blY&NANE pA5l.R0.4T) PHONE F YAM AREA CODE <br /> f47�) Q <br /> IdGIR&NNE(U$i. PHONE PWIH AREA }7DEFpHowdRE FE'mcileR4ggv3NRN�aKzna FRcO Q <br /> IL PROPERTY OWNER INFORMATION-(MUST BECOMPLETED) <br /> NAME -� CM EOFA00RES511FORNATON <br /> i 13 CaLtj flgcflepyiks I,T <br /> fAAA1NKK KA SRIEET ADDKIE{$ =TOM <br /> '��b ED MMUAL CI ux -i1 Ecy C72TATE4MIN <br /> F 1 C CF-N f =TOM C7 FAmrmalr C I GOLMM-AGENCY C]FMA&AGOcr <br /> CRY NAME - STATE PRONE A V TTR AREA CDDE <br /> Gra C 0 0 CA1;0311055,0_7 D • 'i 7 qao O <br /> III. TANK OWNER INFORMATION-(MUST BE COMPLETED) <br /> NAME OF OWD <br /> M CARE CuCP ARESS INFORUATION <br /> til R19Qc`RYIES LT <br /> W NGDRSTPGEAOOFta/aaa� `1 rlaY4dal �tomAL C}UXWAGBM I�STATE�ffBiX <br /> 37 i a13+I a1STI= E30DW MTOO C Nmma%MHR C}CA KMASU Cv O FFDFPA aDF LY <br /> CRY NAME STATE I mPDODE I PHONE I VM AREA CME <br /> To eK1r o tis rAI +5ao-7 Zea I --Q 7$ <br /> IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER-Call(916)322-9669 if questia K arise, <br /> TY('nq ND ®-moo v & 5 <br /> V. PETROLEUM UST FINANCIAL RESPONSIBILITY-(MUSTBECOMPLETED)-IDENTIFY THE METHC[I(S) USED <br /> r m.rms C7*4R"U RO C 1 2 on°wm [71s PanY� =A suRFlY p s IEITEP OPcnEw 0 A;P KESwmw C l T srT Rw <br /> Id(istATERwar.�w(AAcaoRICERLErre+ (�osuTER�aawmRUTEaFLErGsrr ©iamraLmrLI�cAITMN C7 wolTdn <br /> VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal r>0ffi2a m 2rd Mang AN bO SGM IG SIB tw*m m}rote blm 1 a"is dwd(ad. <br /> CHEMONE BOK VAOWVM VOUCH ANDVE ADDRESS JHWD M USHI FOR LEGAL IOYYNJITIMS AMO DOPN& LE] p.E3 "L <br /> THIS FORK HAS aE�N ColotSTM LWDe R PO M TYOFPOLVITY,MD TO ME 6ESTOFNYHNOMEDCE.15'"RUE AND CORRECT <br /> TANK OIANERG NAME OWM®A 9ClN7URE1 TwNUwNrxalRtE d'1' YONi1VOAYMtG1R <br /> Loco( tJ Pp_z,0wE:s I.TD -a26'aA�e� <br /> LOCAL AGENCY USE ONLY <br /> COUNTY t JURISCICTION/ FACIL I iY <br /> ® F!.= <br /> LODATmN CGDE-OPTIOW.L CFSN6uBTRAGTP-O;vO_ gyry1BOR•DEKRICT COOE-OPTIPVAL <br /> THIS FORM MUST BE ACCOMPANIED BY AT LEAST n}OR MORE PERMR APPLICATION-FORM B,UNLESS 7M IB A CN L WE OF SIT6UMVRWTION ONLY. <br /> OWNER MIST FILE THIS PORN WITH THE LOCAL AGENCY IMh.EMWMG TW UNDERGROUND STORAGE'i"ANK REGULATIONS <br /> FOi1M A(SgsJ <br />