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Jun • 9. 2004, 2 09P Environmental 832-5152 . No 2486 P -
<br /> U]Vll"XEx1 PROGRAM CONSIDUDATED 70
<br /> TANIKS
<br /> UNDERGROUND STORAGE TANKS - FA:CMITY l�
<br /> (��= ail Fel•aife) Cyr_
<br /> TYPE or ACTION (i 1.Nr-.W 111"T F13.X1nWAL PS &117 ❑5,CHANOL OV 1NPO>WATMN \"7.r1 lerlAlEMY CLOSED SIZE !so.
<br /> (chw1c nne ikm duly) ❑d•kiAIJom PEWT (Svrcil�CILinge) A&TAW 2D40VED
<br /> []C4 TSWOkAAY Vit
<br /> ilqn.r `a.:,J� -•!P!9�7�` Vii.. Ya.,, �:':'I'. WI :.w.a. _:�^:+C�r-1:. :�,,,-._���t...:C'h:C:�-:-•r �w" „5.. - •A,:;,
<br /> �. 'f 1�,-„ „ yy �7�; �h� �y� ''iv::•�P.:.,..` _ �:�-:�:�"__���' ./,:f•.�fte,i<>'!:
<br /> •:•1' - '1'A' '1'I R4.��` fu;s•74 'LV ;.,•:.. {'•: _� .I,_s °f;I:';s.}'. F-•.:r•�'- .'i::
<br /> syl RassNA :E(U. w p M=IrV NA t arr-a:lse uertc%1 A, j. PACtE i�'
<br /> NEAMTCROSS STARRY All, FACILITY OWNER 7YPt2, a.LOCAL,AGavCy�bLSYRLCT- aw
<br /> CORPORATION U 5.WU`N AMENC7•
<br /> J9M UTO 1.GAS S7AT'lON 3,FARM Q 5.CQNML3tCIAl 1• '❑`2,JND1vAJUAL ❑6.STATE A01NCYt
<br /> ME []2,D1STRI0U TUR C]a.PROCESAOR T6,OTHER ❑3.PARTNE1W4TP ©7.FEDFRAL AGE NC'Y•
<br /> MTAL NUMBU OF TANKS ,aa Is JAoi] +a' •If own►r of LST is•oublie alcm:~aent0 OI svFa�is�r of dirypa0. ou ur +06
<br /> REMAINING AT SITE or snnc imets9 ufAk ahiQll'GFt1�teS dlt t7sT. ITbo is the eoliierOfriSgpi fotthe rant:Ksaldn,�
<br /> q Y.f n-x0
<br /> .>.. ��.�' -- .�,_.���- ::`; '';: -- :i�E:.r�it'�i��' ��;• , 'i�Lw]Y�:�a��o�r..:� �,., ';, � ��, ,_h,;'. -.,l ,;
<br /> ER7'YbwJveRN � +17' PHO r aox•
<br /> MA LING OR 57REET ADD 5
<br /> as STATIi •��. z�A�., al.
<br /> P 1rRTY!]wNJ51i E I-COR.POR.ATION z DMDUAL d.LOCAL AGENCY I DISTRICT ❑C SXATS AGP Gt7
<br /> ❑3.PAR7tiERSHIP 0 5,COUNTY AGENCY- 0 7-FEIDERALAGENCY
<br /> ':1:,L4'Tc.:•. ,YS f, _ _.S).
<br /> '.:��I:Z�f.ii- �r ,;.: '•1: �J[�11J '.t.ir, r4.,_•. �'�a11'".
<br /> trr y, :1' `:•'.liti'i:t:: nl+'•-�� Ji7�:'•V, iv:.vl�:i..�,,•1,,.'.�••:: •J 1+.�.J•.f.� ?I
<br /> ..�5,.::.. ',�,:'�•ai,a+il•n,yrr _ 1� 4.....il•�� � ��... '•i•"� /Q ,. ',
<br /> TANKO OWNER NAM +1+,
<br /> TNE
<br /> '� `O/ •1s.
<br /> -r
<br /> W/11ala,
<br /> OR ET ADDRESS
<br /> ,Qb9o?) 4 -Ld
<br /> CITY Q A1�. Sy T6 +ts• L} 0 !I4.
<br /> TANK OI'MR P,6 1.CORPORATION 2,INDMDUAL U A,LOCAL AC1--NCYfJP47WT O 6.STw AT aUIiNCY Gin.
<br /> ©3.FAMNERSHIP Q 5.COUNTY AOENCY ?,FEDERAL,AGENCY
<br /> _I_, _ _ `,�,�_�.�„�� ../B;:r• ::, �`I';�f F.Ei.- ,-t �:�S,CCOif�x::�,E�!►��Xt.,ua''�;:... =.- a
<br /> �;f,ll�;�'il1?1�t;S�' .;�.-. {,•� n.. .. •.0 n, � :::�.:..�; .r..,�...r-+..r.:•:••'•'. J f
<br /> 1'Y H 44 _ Call 916 322.9669 if SWUM gist
<br /> - `� �':?�^'-• �. ,;.. w4'�•TSN'"-�"�. tRZS1';ON� "��.,� ,,;;•a�.J:,;" •,I'�,,� ':'�.. 1l;1 ,;�:;r,r„ ,;;
<br /> • •'`I+, "• - � •,�i���h n,•��• ,^'M+ �'r. R'�I.. :I:"11„I�:.rH...,�•1�,'_I. �,iC� :.=, I. �
<br /> INUICAT8KMIOD(g) '1101.5EU--AMj3En 04.5URETYBOND ZTATE1'UND pI0,LOCAL GOt"TMECNANTW .0
<br /> 2,GUAAAN1Wi . ❑f,LETIPA OF CRMIT 'd.STASE FUND&CFO LETTIM ❑0.GDW:
<br /> 3.C41AANCE ❑ P.STATE FUND&CA
<br /> 1•• _.,SYlar •.I.Yfli wi'.�'�_: -K'. 'Ir ��� �•�1%,•�_a.a.iHA�.Y".v_AL�.�.Y' ,,C:��
<br /> COC,Ck ane VON 0)indietts.lbcb addms ehmuld tx:wal?w Irtal 110113 dcOM and twilins'
<br /> 1.TANK OWNER
<br /> I cx3t rtetlAquOne ind+m� nes �be eeut ID W=talk mwnet%mic!o boc t as i is alteottza ❑ 1.FACILITY 2. PROPERTY OWNER ❑
<br /> ;I7:;'- sti; r-•- ':C.I': ..r� __��}!_ w' /1 "' .i�SI:,"":.;:,. -_ •r"w: _ ':�.� _
<br /> !' rY,.j�l:, - �A 'III• ... ' .1f' VJ���.,��-i•,a
<br /> •CuItAOuIoK !cellisy CIOt fAe ia&rmali0rt tnavided hcrvia is Cuc 3hd utuMle fO the tat Of fr%v IcAcwh dp-
<br /> DATE a�1 PHONE +�s,
<br /> 5I � •1bS'153Z
<br /> 11A__�ME - CA rtnt TiTLLEE�OFAPPLICANT e
<br /> VV
<br /> STATE F UST PACILL fY NLJh CA a(A�cary Gee a+tyl
<br /> AN. 1993 UTGI;2AAC MTIFICATE NLIMBM t4awy we 010y) 'T0
<br /> (Soe Dati•I:lcmcgt i,Above.
<br /> f11N!;'11�Avrn.e ru00i.in ►.._u,«. s+__. ._.. aA• •"'
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