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APPLICATION FOR p ERMIT -.101TO OPERATE STATE ID NUMBER 00000021477( <br /> QSL Ol NEW PERMIT UNDERGROUND <br /> 02 CONDITIONAL PERHIT ( ) 05 RENEWED PERMIT STORAGE TANK <br /> ( ) 06 AMENDED PERM,T ( ) 07 TANK CLOSED <br /> I OWNER ( ) 08 MINOR CHANGE (NO SURCHARGE) ) 09 DELETE FROM FILE (NO FE <br /> N'.'1!!CORPC PAT ICN,IN'DZVIDUAL OR PUBLIC C A FREIGHTWAYg GENCY) <br /> STREET ADDRESS PUBLIC AGENCY <br /> 175 LINFIELD DRIVE ( ) O1 FED ( ) 02 <br /> cxrr STATE ( 1 03 LOCAL <br /> II FACILITY MENLO PARK STATE ZIP <br /> CA 94025 <br /> FACILITY NAME <br /> CONSOLIDATED FREIGHTWAYS <br /> ACD PE SS DEALER/FOREMAN/SUPERVISOR <br /> ,"n SOUTH AIRPORT WAY <br /> CITY <br /> NEAREST CROSS STREET STOCKTON FRENCH CAMP ROAD <br /> COUNTY <br /> ADDRESS SAN JOAQUIN ZIP <br /> G434 SOUTH AIRPORT WAY cxry 95206 <br /> PHONE W/APEA CODE STOCKTON STATE IIP <br /> 209-982-4813 TYPEof BUSINESS CA 95206 <br /> CONTAINERS NUM3" OF CDN; ( ) 01 GASOLINE STATION (X) 02 OTHER COMMON CARRIER <br /> 1 MORAL AREAS ONLY : TOWNSHIP <br /> RANGE <br /> SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> �:AYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> r0 209-982-4813 NIGHTS: NAME(IAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-982-4813 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR CONTAINER <br /> V DESCRIPTION <br /> (Xl 01 TANK ( ) 04 OTHER: <br /> CONTAINER NUMBER D1 <br />(S. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: 1972 C. YEAR INSTALLED 1972 [ ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) 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 ( ) 02 REGULAR l ) 03 PREMIUM (X) 04 DIESEL l ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> a <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( 1 GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED L4).02 SINGLE WALLED f 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> f 1 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> ISC04-070185 (10/18/85) PAGE 1 <br /> 'RR <br /> STATE ID NUMBER 00000021477001 <br /> CONTAINER CONSTRUCTION <br /> E. ( 1 01 RUBBER LINED ( ) 02 ALKYD LINING ( ) 03 EPDXY LINING l ) 04 PHENOLIC LINING ( 1 05 GLASS LINING <br /> (XI 07 UNLINED ( ) 08 UNKNOWN ( ) 09 OTHER: <br /> F. ( ) 01 POLYETHLENE WRAP f ) 02 VINYL WRAPPING ( ) 03 CATHODIC PROTECTION (X) 04 UNKNOWN ( 1 05 NONE <br /> ( ) 06 TAR OR ASPHALT ( ) 09 OTHER: <br /> VI PIPING <br /> A. ABOVEGROUND PIPING: ( ) 01 DOUBLE—WALLED PIPE ( 1 02 CONCRETE—LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE ( ) 05 SUCTION ( ) 06 UNKNOWN ( ) 07 NONE <br /> B. UNDERGROUND PIPING: ( ) 01 DOUBLE—WALLED PIPE ( 1 02 CONCRETE—LINED TRENCH ( ) 03 GRAVITY <br /> (CHECK APPROPRIATE BOX(ES) ( ) 04 PRESSURE (X) 05 SUCTION ( 1 06 UNKNOWN ( 1 07 NONE <br /> VII LEAK DETECTION <br /> 1 ) 01 VISUAL = 02 STOCK INVENTORY �&04 VAPOR SNIFF WELLS ( l 05 SENSOR INSTRUMENT <br /> .jL06 GROUND WATER MONITORING WELLS ( ) 07 PRESSURE TEST ( ) 09 NONE ( 110 OTHER: <br /> � II <br /> CHEMICAL COMPOSITION OF MATERIALS STORED IN UNDERGROUND CONTAINERS <br /> ) F YOU CHECKED YES TO IV-F YOU ARE NOT REQUIRED TO COMPLETE THIS SECTION <br /> A(NTLY PP.EVZ CUSLY OELITE CAS# (IF KNOWN) CHEMICAL (DO NOT VSE COMMERCIAL NAME) <br /> -0 STOPED <br /> 01 ( ) 02 ( l 03 <br /> 01 f l 02 ( l 03 I I <br /> 01 ( 1 02 ( 1 03 <br /> 01 ( 1 02 ( ) 03 <br /> ( 1 <br /> 01 ( 1 02 ( ) 03 I I <br /> ( 1 01 ( 1 02 ( ) 03 <br /> ( ) O1 ( 1 02 ( ) 03 <br /> c101 O02 ( ) 031111111111111 __ <br />