Laserfiche WebLink
IFIED PROGRAM CONSOLIDATED FCW <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - FAC - <br /> (on pag410 Me_of <br /> TYPE OF ACTION ❑ 1.NEW SITE PERMIT ❑3.RENEWAL PERMIT ®5.CHANGE OF INFORMATION LY CLOSED SITE <br /> (Check one item only) ❑4.AMENDED PERMIT specify change local use only _. o�� Ty <br /> ❑&TEMPORARY SITE CLOSURE ENCy SERV400 <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> h <br /> 7-Eleven 32262 <br /> NEAREST CROSS STREET !401 FACILITY OWNER TYPE 4.LOCAL GENCY/DISTRICT* <br /> 2360 W Grantline Rd.,Tracy, CA 1.CORPORATION ❑5.COUNTY AGENCY* <br /> BUSINESS [11.GAS STATION [13.FARM [15. COMMERCIAL ❑ 2.INDIVIDUAL ❑6.STATE AGENCY* <br /> TYPE [12.DISTRIBUTOR [14.PROCESSORS 6. OTHER 403 ❑ 3.PARTNERSHIP ❑7.FEDERAL AGENCY* 402 <br /> TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST is a public agency:name of supervisor of division,section or office <br /> REMAINING AT SITE trustlands? which operates the UST(This is the contact person for the tank records.) <br /> 3 404 ❑ Yes S No 405 406 <br /> PROPERTY OWNER NAME 407 PHONE 408 <br /> WECI-99-6 LLC 972-361-5000 <br /> MAILING OR STREET ADDRESS 409 <br /> 15601 Dallas Parkway, Suite 400 <br /> CITY 410 STATE 411 ZIP CODE 412 <br /> Dallas TX 75001 <br /> PROPERTY OWNER TYPE AI.CORPORATION ❑2.INDIVIDUAL ❑4.LOCAL AGENCY/DISTRICT ❑6.STATE AGENCY <br /> [:13.PARTNERSHIP [15.COUNTY AGENCY ❑7.FEDERAL 413 <br /> 7TANKOWNER NAME 414 PHONE 415 <br /> -99-6 LLC 972-361-5000 <br /> G OR STREET ADDRESS 416 <br /> 15601 Dallas Parkway, Suite 400 <br /> CITY 417 STATE 418 ZIP CODE 419 <br /> Dallas TX 75001 <br /> TANK OWNER TYPE 1.CORPORATION ❑2.INDIVIDUAL ❑4.LOCAL AGENCY/DISTRICT ❑6.STATE AGENCY 420 <br /> ❑3.PARTNERSHIP ❑5.COUNTY AGENCY ❑7.FEDERAL AGENCY <br /> *(TK) 44- Call (916)322-9669 if questions arise 421 <br /> INDICATE ❑ 1.SELF-INSURED [14.SURETY BOND ❑7.STATE FUND ❑ 10.LOCAL GOVT MECHANISM <br /> METHOD(s) ❑2.GUARANTEE [15.LETTER OF CREDIT ❑8.STATE FUND&CFO LETTER ❑ 99.OTHER: <br /> 3.INSURANCE [:16.EXEMPTION ❑9.STATE FUND&CD 422 <br /> Check one box to indicate which address should be used for legal notifications and mailing. <br /> Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ❑ 1.FACILITY ❑2. PROPERTY OWNER 3.TANK 423 <br /> OWNER <br /> Certification-I certify that the information eMerein is true and accurate to the best of my knowledge. <br /> SIGNATURE OF APPLICANT $.. DATE 424 1 <br /> 5PHONE 03-977-7713 <br /> 425 <br /> NAME OF APPLICANT(print) 426 TITLE OF APPLICA T 427 <br /> Bob DeNinno Environmental Manager, 7-Eleven, Inc. <br /> STATE UST FACILITY NUMBER(Forlocal use only) 428 1998 UPGRADE CERTIFICATE NUMBER(For local use only) 429 <br /> UPCF(1/99 revised) 0 0 Formerly SWRCB Form A <br />