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STATE ID NUMBER 00000059694 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT ( 7 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> f ) 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEE) <br /> I <br /> I OWNER <br /> NAME(CORPORAT1ON.INDIVIDUAL OR PUBLIC AGENCY) <br /> ALBERT INHOF PUBLIC AGENCY ONLY <br /> f l 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS <br /> 3566 11TH STREET cx7r STATE ZIP <br /> TRACY CA 95376 <br /> II FACILITY <br /> FACILITY NAM! <br /> ALBERT INHOF DIALER/FOREMAN/SUPERVISOR <br /> STREET ADDRISS <br /> 3566 11TH STREET NEAREST CROSS STREET <br /> CITY <br /> COUNTY <br /> TRACY Zip <br /> SAN JOAQUIN 95376 <br /> MAILING ADDPESS CITY STATE ZIP <br /> 3566 11TH STREET TRACY CA 95376 <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-835-3842 ( ) 01 GASOLINE STATION ( 7 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> I <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(IAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(lAST NAME FIRST) AND PHONE W/AREA CODE <br /> ALBERT IMHOF 209-835-3842 SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: 1965 C. YEAR INSTALLED 1965 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( l 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ESI: <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS [ ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> l ) 06 ALUMINUM ( 107 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />