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I <br /> STATE ID NUMBER 00000001394001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (W 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( l 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SCOTTY'S BAIT & TACKLE, INC. ( ) 01 FED ( ) 02 STATE t ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 2420 W. GRANTLINE TRACT CA 95376 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SCOTTY'S BAIT & TACKLE, INC.#2 DEBBIE SCOTT WI#4 60 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 574 W. GRANTLINE TRACY BLVD. <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAgUIN 95376 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 574 W. GRANTLINE TRACY CA 95376 <br /> PHONE Wi.AREA CODE TYPE OF BUSINESS <br /> 209-835-3415 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER. OF CONTAINERS RURAL AREAS ONLY :TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST ,NAME FIRST) AND PHONE W/AREA CODE NIGHTS: N.AME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> DEBBIE SCOTT (y)poo 209-835-0729 SCOTT,DEBBIE)t"066 209-835-3671 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: TC. YEAR IN (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 8000 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( ) 06 OTHER <br /> V - CONTAINER CONSTRUCTION _ <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE Zt-f"INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED tom) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( l 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CCNCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD ( l 08 BRONZE ( ) 09 COMPOSITE ( l 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />