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STATE ID NUMBER 00000001472002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 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.INDIVZDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CONTINENTAL TELEPHONE COMPANY ( ) O1 FED l ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE 2IP <br /> 16071 MOJAVE DRIVE VICTORVILLE CA 92392 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> AG )h8a 1 MORGE r„PrzWcs <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 17855 SO. COMCONEX HWY. 120 <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADCPESS CITYSTATE iIP <br /> Z7066 W.� Zi MANTECA CA 95336 <br /> PHONE W/.AR!4 CODE TYPE OF BUSINESS 7 Z 1yy.t(n <br /> 209-239-4tE7-0 WAt 01 GASOLINE STATION 04J 02 OTHER 1{�{p�(�' <br /> NUMBER OF CONTAIN!RSRURAL 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 NZOHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> G[BRBE{HMMIMB6 209-239-k2'4�0 _ <br /> '-----COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 10000 8ALLONS f 1 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 /> (XI 01 UNLEADED ( ) 02 REGULAR [ ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE l ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) i4. 02 NON-VAULTED 0E3 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( 1 03 LINED <br /> 0. ( 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( l 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />