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STATE ID NUMBER 00000001472001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> FL) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED l 1 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.POP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CONTINENTAL TELEPHONE COMPANY I( ) 01 FED ( ) 02 STATE ( ] 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 16011 MOJAVE DRIVE VICTORVILLE CA 92392 <br /> II FACILITY <br /> FACILITY NAME ,I DEALER/FOPEMAN/SUPERVISE <br /> M(� Gpr�'Pn�wT�l� T e--IdlrL ICe <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 17855 SO. COMCONEX HWY. 120 <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS CITY STATE ZIP <br /> !� MANTECA CA 95336 <br /> PHO209N239 APEA-43a-1 CODE rvOF SUSIN SS <br /> � OS GASOLINE STATION 00 02 OTHER _p <br /> 24 <br /> NUMBER OF CONTAINERSRURAL 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: NAME(,LLAST NAME FIRST)�AND <br /> �PHONE W/AREA CODE <br /> �WSS. 209-239-4let000cr '�nYf7 j "((� .,)07 DD/ <br /> VOC <br /> OMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK [ ) 04 OTHER: CONTAINER NUMBER 1 <br /> S. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 5000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X1 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 02 NON-VAULTED OH 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( l 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE f ] 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( ) OB BRONZE f ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> t <br />