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STATE ID NUMBER 00000008170003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 NEN PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE)] <br /> 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) i <br /> I OWNER <br /> NAM!(CCRPOPATION.INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> TIME OIL CO. ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 2737 W. COMMODORE WAY SEATTLE WA 98199 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> JACKPOT VINCENT F. BLANK <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 7200 S. EL DORADO HWY. 50 <br /> CITY COUNTY ZIP <br /> FRENCH CAMP SAN JOAQUIN 95231 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 7200 S. EL DORADO 9)IW!' wca, 95231 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-982-9813 (X) 01 GASOLINE STATION ( 1 02 OTHER <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/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> STINE, GEORGE E. 707-425-7195 SAME - - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 417 <br /> B. MANUFACTURER (IF APPROPRIATE): MODESTO WELDING YEAR MFG: 1972T C. YEAR INSTALLED 1972 f ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 12000 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 /> ( ) 01 UNLEADED (1(T 02 REGULAR l ) 03 PREMIUM ( ) 04 DIESEL l ) 05 WASTE OIL =06 OTHER -*+. 9-?M966FhfE <br /> V CONTAINER CONSTRUCTION <br /> D <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( l UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( 1 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE ( ] 09 COMPOSITE ( ] 10 NON-METALLIC <br /> ' ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070585 (10/18/85) PAGE 1 <br /> r <br />