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' STATE ID NUMBER 00000014568002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 0-{EW PERMIT l l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> F( 1 02 CONDITIOFAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> �1 � ( ) O1 FED ( ) 02 STATE l ) 03 rLOCAL <br /> STREET ADDRESS CITY n STATE IIP I7.117 <br /> 10ii-fRCGOiR3 ST.; _- QQ. - O I�TTBY4✓aCYt_J�OGk &W2 <br /> II FACILITY <br /> FACILITY NAME �� T' DIALER/FOREMAN/SUPCRVISOR l l <br /> u P *nmt GJ "Rq c, R i <br /> STREET ADDRESS NEAREST CROSS STREET V <br /> 757 E. 11TH ST. EAST ST. <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 95376 p` <br /> MAILING A�O�D P.ESSJ O C�ITY�� `� CTAATE ZIP <br /> loo <br /> PHONE W/AREA CODE TYPE) OF BUSINESS <br /> 209-835-0570 ( 01 GASOLINE STATION (X) 02 OTHER FOOD PROCESSING PLAN <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <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 /> STAAS, R.N. 209-835-0570 FRAZER, ROGER 209-835-0570 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TAMC ( ) 04 OTHER: CONTAINER NUMBER X845493 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS WELDING WORKS YEAR MFG: 1982 C. YEAR INSTALLED 1982 f 1 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 /> l l 01 UNLEADED l ) 02 REGULAR ( 103 PREMIUM (X) 04 DIESEL l 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( 1 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 /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL [ 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE f ) 10 NON-METALLIC <br /> l ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />