Laserfiche WebLink
Jan 22 03 06: 45p Rr' Robertson 209176 p. 3 <br /> nl/lf1/rnn.{ 11:'L'1 /N4 4;33 FIFTH FI MR I72-3PAGE %'1 <br /> UrfIFTE'D PROGRAM CONSOLFOATED.FORM rnV:PRO2.12519 <br /> p /[4F#3 FAC 0:FA000DW" <br /> UNDERGROUND STORAGE TANKS-FACIL Y levr- <br /> (One PICA,Per sire) <br /> (TYP�E OF ACTION [1 1.NEW S1TF.P$)LN IT X BENE WAL PEL"JIT S CIrANGE OF 1Nfr)RMALON 7.PEQMA <br /> ukoncimmanly) L� N6N'1bYCLUS£US)TI <br /> ❑a.nME,YDED PU2MfT ❑9-TANK UIR40VF0 <br /> T P^� <br /> ❑ Srr�'cr%UREr <br /> 1.FACILITY/SITE INFOIRMAT)ON .633 E VIC.To (ZD yLonj <br /> 11USINE65NAI IS,..�dePAQuirH�Mc..pnA,p,twBw,•�rAt) t hAC:1UT - <br /> 1�OR�15 76" FAQUpp48?1 rLZD�31519 1 ' <br /> AIEAI+i-57'CROSS S'lREBT '• "� FAG Y UW'4zK TYPE <br /> VICTOR 461 ❑4•LOCAL ACTE1-CY/Dj57=T• <br /> IlUS1NE55 ❑ 1•CORPOKATTON O 5•AN(INTYAGFNCY- <br /> ® I.I)ASSTATION 1 FA;0A ❑2.INmVLDUAL <br /> TYPE ❑ 711d,-�COMMERCIAL ❑6.STATF AC:FNCY- <br /> ❑2,DISTRloviOA ❑{,rROCEsSORon•rPR 107 ❑7,PARTtiERSH1P F-11?1C1T[luLACE]ary 407 <br /> T07AI NUG AT SITE <br /> TANi�S b lScility nn A�titnt or •I(owaef atUST ic4Dnb4etwCucy:aaftie efecOcroiaore(aid:ien•c!a1Pq orottliec-hick apcmtgb <br /> RPMAIN'WG AT St7I; atutl.teiU' <br /> Lac UST(This i6 she<oOLLct Fuson far Gx tank scorns.) <br /> °tl Cl Yes No 'at HEINZ,DALE 209-948.9412 <br /> IT.PROPERTY OW;YER INFORMATION <br /> PRUPEICI'Y UtiVNER NAME 4QT PHONE <br /> IGVOX EIvTEILPRISES +oe <br /> MAILMt;UR �r Ann;tEss - , .. 204 367.7516 <br /> 633$EAST VICTOR RD +6P <br /> C'lly " .. . ;1P SI'AIE II L11'COUL �i• <br /> LO <br /> DI CA-- I 95240 <br /> YROPLRTY OWNF T I I COKPORATK]N ❑ 2.INDIY(DUAL 0 A.LOCAL.ACPNCY f DISTRICI' ❑a.STATE AGENCY <br /> ❑1.PAR T!\ERSIiIP O s.COLNTY AGENCy rJ 7 PCOCAN,AGENCY at, <br /> III.TANK OWNER INFOR-MATION <br /> TnNSOWNEANAME ,i4 PHUNE — a I <br /> W00T.SFY OIL INC {209 946-9412 <br /> MAIL)::GORSTPtrbl ADDRIiSS <br /> 166 FRANK WEST CIR ns <br /> Cl1 Y 11 STAT E 412 GIP COX <br /> STOCKTON' CA 95206 4•, <br /> 7An.k L)Y✓NFJC TY PL CORPORATION ❑2.1NDnrrDVA,i, ❑4.L0C.AL AaNCY i DISTRICT ❑ 6.STATL•AGENCY Oro <br /> - ©3.i,-R-rNCRsw I]D.CC7LTTY AGENCY ❑7,RVE AL AGENCY <br /> IV.BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NVMBER <br /> 7Y{TK.)HQ 44 44-037684 _ Call,(916)322-9669 if questions arise •" <br /> V.PETROLEUM LIST FINANCIAL RESPONS)BILI'I'Y <br /> INDICATE M2:THOD(6) G I.SL•LF.IN.Mll L;4.SURETY BOND <br /> A T.ST'ATL•FUND ❑10.LOCAL GOVT IvZCltA1IISti! <br /> ❑2.GUARANrEF. U 5.LETTER OF CkLD1T © 8.STATE FUND&CPD r.ETTF.R xO 99.OTHER <br /> L7 3 INSURANCE ❑6.LXEMPTION © 0.$TAIL P UyU A!CU 421 <br /> VI.LEGAL NOTIFICATION AND MAILING ADDRESS <br /> Check one boa to inJie..rr,which�ddrpsi fAou10 tc ua�d fw Icy,/naciRcallons OrHl u7ii4aS. °� <br /> ® I.FACILITY ❑2.PROPERTYOMER ❑3.'fANy owNER <br /> 4341 notifieinion+i6d mailing.nn he wet to IAL yank o-n..unless Law i-.?u chocked. <br /> Vil.APPLICANT smNArtiRr <br /> CCA1 PG •Ili 'fj tfal d4 in(ommuml jffwitlad herein ea wa and ecoureu ro we bc41 olmy knowltags. - ... <br /> S) HATS. <br /> AT TI)A'l Y14 YLjONG - 42e <br /> 7 03 <br /> rA Or ArTUCANT(print) 11111 L.E.OF APT! C.'.w 427 <br /> STATE UST hACILITY NWI1LR IYm Isnl of 01i» 67e 1998 Ul'(iRAD.G CE)t'TL7CATE WldAFR(sa wvt,a�.t.1 4tv <br /> Ts)996 ComphanlT Y <br /> UPCF(1/99 TcvisrfJ) <br />