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STATE ID NUMBER 00000064424003 <br /> APPLICATION FOR PERMIT TO RATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT f i 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> l I OWNER <br /> N.AME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SAFEWAY STORES. INC. ( 1 01 FED l 1 02 STATE ( 1 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 /> STFE°T ADDRESS NEAREST CROSS STREET <br /> 1320 S. AURORA STREET CHARTER WAY <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAGUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 8779 STOCKTON CA 95208 <br /> FMONE W/AREA C07E TYPE OF 9U SI NESS <br /> 209-948-0681 f 1 01 GASOLINE STATION (X) 02 OTHER SAUSAGE PLANT <br /> NUMBER OF CONTAINEPS RURAL 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(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. f ) 01 TANK (XI 04 OTHER SUMP CONTAINER NUMBER 3 <br /> B. MANUFACTURER [IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (X1 UNKNOWN E. DOES THE CONTAINER STORE: (X1 O1 WASTE ( ] 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL (X) 06 OTHER UNKNOWN <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> 0. ( 7 01 CARBON STEEL [ 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE X) 05 CONCR <br /> f ) 06 ALUMINUM [ l 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE [ 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> MSC04-070185 (10/18/85) PAGE 1 <br /> S <br />