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J STATE ID NUMBER 00000064424002 <br /> APPLICATION FOR PERMIT TOERATE UNDERGROUND STORAGE TANK <br /> ( 1 <br /> 01 NEW PERMIT f 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAFEWAY STORES, INC. ( ) 01 FED 1 ) 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 2800 IGNACIO VALLEY ROAD WALNUT CREEK CA 94598 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SAFEWAY SPECIALTY SAUSAGE PLAN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1320 S. AURORA STREET CHARTER WAY <br /> CITY COUNTY Zip <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING AODPESS CITY STATE ZIP <br /> P.O. BOX 8779 STOCKTON CA 95208 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-948-0681 ( ) 01 GASOLINE STATION (X) 02 OTHER SAUSAGE PLANT <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/ARCA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> ED STRANGE 209-745-3821 M.H. MORSE 209-951-7295 <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: GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE f 1 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 /> ( ) <br /> 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL (X) 06 OTHER UNKNOWN <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f 1 INCHES ( ) CM (X) UNKNOWN ` <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X1 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f 1 03 LINED <br /> SA <br /> 0. ( l 01 CARBON STEEL ( l 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE (X1 05 CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD ( ) 08 BRONZE f 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> f 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br />