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STATE ID NUMBER 00000008155001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> r701 NEW PERMIT l 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM!(CORPORATION,ZNDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> TIME OIL CO. I( ) 01 FED ( ) 02 STATE f 1 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 2737 W. COMMODORE WAY SEATTLE NA 98199 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> JACKPOT VINCENT F. BLANK <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 401 S. CHEROKEE LANE LODI AVE. <br /> CITY COUNTY IIP <br /> LODI SAN JOAQUIN 95240 <br /> MAILING ADDRESS CITY �� STATE ZIP <br /> 402 S. CHEROKEE LANE SAWE_ 95240 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-369-5624 (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 /> GAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAMLf LAST NAME FIRST) AND PHONE W/ARCA CODE <br /> HIGNIGHT, STEVEN C. 916-423-1998 SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TAMC ( ) 04 OTHER: CONTAINER NUMBER 411 <br /> B. MANUFACTURER (IF APPROPRIATE): BUTLER MFG. YEAR MFG: 1959 C. YEAR INSTALLED 1959 f 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 4000 GALLONS [ 1 UNKNOWN E. DOES THE CONTAINER STORE: f 1 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 /> ( 1 <br /> 01 UNLEADED f 1 02 REGULAR (x-03 PREMIUM ( ) 04 DIESEL l 1 05 WASTE OIL Lier0 uD re m TtiR <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE' (X) INCHES ( ) CM ( 1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL f 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE l l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 06 BRONZE ( 1 09 COMPOSITE 1 ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />