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-7
<br />�'D PROGRAM COMS-01ADATED FOro
<br />TANKS
<br />U-NDIERGRI 17ND STORAGE TANKS - FACILITY
<br />Ull y 1117 -sit 1 '"rVr. 4:9
<br />bo., ,
<br />TANK OWNER TYPE El 1, CO.VORATION Lj 2. INDIVIDUAL 0 4. LOCAL AGENCVDISTRICT U 6. STATE AGENCY 420,
<br />;al PARTNFRSHM ❑ 5. COUNTY AGENCY E] 7. FEDERAL ACV4CY,
<br />W. 77.
<br />WWI,
<br />..... .... .
<br />TY (TIC) HR. 44- Call (916) 322-9 69 if qucstio= mmse
<br />INDICATE METFOD(s) Lj 4, sT-mm BOND -ja 7. S; ATG FUNIP Ll 10. LOCAL GOVT NIEC.4ANigm
<br />Z tYJARANM E35.=ER 0FCREDIT M 2-4,4TATEFLIM & CFO LETTER D 10 077 -MR!
<br />3. 'Nnmma IJ ti. EXENLPTION ❑ 9. STATE FUND iz CD
<br />!c
<br />. . . ....
<br />Check ow box to -l'oftum which iddmat gkOd be upki for lop] con ns alD4 madiug.
<br />rAgpl motffiradan and midEWwil be umt to the tank owner um:vss box I or 2 is chmloi ❑ 1. tACIL,= ❑ 2 PROPERTY OWNER S. 7,%JVK OWNER 4m-
<br />.. .... .....
<br />. . ..... ANT.
<br />AT]
<br />cadrmim I gritify an. the fAfm=tou provided tacin is ne and =Unle Eo (Jie bO-14 ofmy1cmuledge.
<br />SIGNAIUREO 5 APPLICANT DATE 444
<br />RA OF APPLICAN?CPT ft,) 43C 1 TITLE 9AFFLICANT
<br />I.A 2:L J,,
<br />2.
<br />STATE UST FACILITY NUMEItDarcy a*rN)
<br />(Su Data Elev=t 1, above.
<br />vpCF.Hwhm4 (11") -1J: Rcy, 81,16/00
<br />1, Alp, 11
<br />PROPERTY OWNER NAME
<br />(One Fazz per S(T-i) Fay. of -
<br />TYPR OF ACTION C3 I. NEW PEPUIT 3. REqEWAL FtP-?AF 5- CHANGE OF lXFcPMArI0N PMM-VqBNny CLCZED SITE
<br />:2 1> �F) 33y- 3a3 3 1
<br />,C'Wcx MR item only) ❑-t AMMMW FZMaT (Spteii4j cimnge) vaixpmiovEn
<br />G. MIYOORARY SITE CLOSUXE
<br />C ITY 41 C.
<br />STATE OIL. -r CODE
<br />FIAT
<br />PROPS.TrY OINNER 7M Ljl.C()RPn-RAT-ION [12.NDIVMUAL
<br />L:14.LOCALAGRNCYiDlSTRJCT Ij 6. STATE AGENCY'
<br />B�JSINLSS NAME (s.,.. rAauTyNAMZ m DBt - D�iag rujinm As) 3. FAC:LITY
<br />TANK OWNER NAME
<br />PYONE 1
<br />rD0
<br />3 P 33
<br />M,kTUNG OR STREET ADI2Vt=
<br />'nV I
<br />NEAREST CROSS S STREET ao,.
<br />FACILITY OWN,ER-,Y?w L❑14. U VCVDIS-T,IC
<br />" �44y), 2-.* 'N
<br />CORPORATION C S. ccuNrY AG-,-,NCY-
<br />❑ 2. R,*riII)UAL IM 6. STATE AGENCY-
<br />BJSINESS-FZ9 !.GAS STATION 3. FARM [l5,C0%LMEP.C5T-403-
<br />; TYPE Cj 2, DISTRMUTOP, C3 4. PROCESSOR M 6.OTHER
<br />3. PARTINERSMF El 7. FEDERAL AGENCY'
<br />TOTALL NL m B ER OF TANK 3
<br />Iii, 0wmv,�fJST -:& s pubhc age% -
<br />y: Mme of supervisor of divistar4 lee -doll
<br />P-tVAl",N-4NG AT SITE or trat land3?
<br />a a0 - -
<br />r-, --- r7xe-
<br />Ull y 1117 -sit 1 '"rVr. 4:9
<br />bo., ,
<br />TANK OWNER TYPE El 1, CO.VORATION Lj 2. INDIVIDUAL 0 4. LOCAL AGENCVDISTRICT U 6. STATE AGENCY 420,
<br />;al PARTNFRSHM ❑ 5. COUNTY AGENCY E] 7. FEDERAL ACV4CY,
<br />W. 77.
<br />WWI,
<br />..... .... .
<br />TY (TIC) HR. 44- Call (916) 322-9 69 if qucstio= mmse
<br />INDICATE METFOD(s) Lj 4, sT-mm BOND -ja 7. S; ATG FUNIP Ll 10. LOCAL GOVT NIEC.4ANigm
<br />Z tYJARANM E35.=ER 0FCREDIT M 2-4,4TATEFLIM & CFO LETTER D 10 077 -MR!
<br />3. 'Nnmma IJ ti. EXENLPTION ❑ 9. STATE FUND iz CD
<br />!c
<br />. . . ....
<br />Check ow box to -l'oftum which iddmat gkOd be upki for lop] con ns alD4 madiug.
<br />rAgpl motffiradan and midEWwil be umt to the tank owner um:vss box I or 2 is chmloi ❑ 1. tACIL,= ❑ 2 PROPERTY OWNER S. 7,%JVK OWNER 4m-
<br />.. .... .....
<br />. . ..... ANT.
<br />AT]
<br />cadrmim I gritify an. the fAfm=tou provided tacin is ne and =Unle Eo (Jie bO-14 ofmy1cmuledge.
<br />SIGNAIUREO 5 APPLICANT DATE 444
<br />RA OF APPLICAN?CPT ft,) 43C 1 TITLE 9AFFLICANT
<br />I.A 2:L J,,
<br />2.
<br />STATE UST FACILITY NUMEItDarcy a*rN)
<br />(Su Data Elev=t 1, above.
<br />vpCF.Hwhm4 (11") -1J: Rcy, 81,16/00
<br />1, Alp, 11
<br />PROPERTY OWNER NAME
<br />WT. I PVCKE 403.
<br />C;
<br />:2 1> �F) 33y- 3a3 3 1
<br />MAZINQ OR STREET AWRESS
<br />C ITY 41 C.
<br />STATE OIL. -r CODE
<br />PROPS.TrY OINNER 7M Ljl.C()RPn-RAT-ION [12.NDIVMUAL
<br />L:14.LOCALAGRNCYiDlSTRJCT Ij 6. STATE AGENCY'
<br />-al PAFL-1 WERSHYP L -j 5. COUNTY AGENCY ❑7. FEDERAL AGeqCY
<br />TANK OWNER NAME
<br />PYONE 1
<br />3 P 33
<br />M,kTUNG OR STREET ADI2Vt=
<br />'nV I
<br />Ull y 1117 -sit 1 '"rVr. 4:9
<br />bo., ,
<br />TANK OWNER TYPE El 1, CO.VORATION Lj 2. INDIVIDUAL 0 4. LOCAL AGENCVDISTRICT U 6. STATE AGENCY 420,
<br />;al PARTNFRSHM ❑ 5. COUNTY AGENCY E] 7. FEDERAL ACV4CY,
<br />W. 77.
<br />WWI,
<br />..... .... .
<br />TY (TIC) HR. 44- Call (916) 322-9 69 if qucstio= mmse
<br />INDICATE METFOD(s) Lj 4, sT-mm BOND -ja 7. S; ATG FUNIP Ll 10. LOCAL GOVT NIEC.4ANigm
<br />Z tYJARANM E35.=ER 0FCREDIT M 2-4,4TATEFLIM & CFO LETTER D 10 077 -MR!
<br />3. 'Nnmma IJ ti. EXENLPTION ❑ 9. STATE FUND iz CD
<br />!c
<br />. . . ....
<br />Check ow box to -l'oftum which iddmat gkOd be upki for lop] con ns alD4 madiug.
<br />rAgpl motffiradan and midEWwil be umt to the tank owner um:vss box I or 2 is chmloi ❑ 1. tACIL,= ❑ 2 PROPERTY OWNER S. 7,%JVK OWNER 4m-
<br />.. .... .....
<br />. . ..... ANT.
<br />AT]
<br />cadrmim I gritify an. the fAfm=tou provided tacin is ne and =Unle Eo (Jie bO-14 ofmy1cmuledge.
<br />SIGNAIUREO 5 APPLICANT DATE 444
<br />RA OF APPLICAN?CPT ft,) 43C 1 TITLE 9AFFLICANT
<br />I.A 2:L J,,
<br />2.
<br />STATE UST FACILITY NUMEItDarcy a*rN)
<br />(Su Data Elev=t 1, above.
<br />vpCF.Hwhm4 (11") -1J: Rcy, 81,16/00
<br />
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