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`J STATE ID NUMBER 00000003443004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (14 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> R. E. DEGNAVEL ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADORES$ CITY STATE ZIP <br /> P. 0. BOX 1376 LA MESA CA 920410210 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREM N/SVPERVISOR <br /> CARNIEGIE AUTO/TRUCK PLAZA <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 446-00 S. CORRAL HOLLOW RD 3pCOCO <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADDRESS �,n G CITY STATE ZIP <br /> S. CORRAL HOLLOW RD loboo TRACY CA 95376 <br /> PHONE W/ARCA CODE TYPE OFBUSINESS <br /> 209-836-3805 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS_ RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 8 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME( AST NAME FIRST) AND PHONE W/ARCA CODE NIGHTS: N)ME NAME IRS ) AND PHONE W/AREA CODE <br /> 209-836-3805 K5$' <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) Ol TANK ( 1 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (Xl 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f ] <br /> 01 UNLEADED f ) 02 REGULAR f 1 03 PREMIUM (X) 04 DIESEL l ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: l I GAUGE l ) INCHES f I CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 02 NON-VAULTED NLi 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS [ 1 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD f 1 08 BRONZE f 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />