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STATE ID NUMBER 00000004291002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (� m ucu ocernu_ ( ) 05 RENEWED PERMIT t ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT f ! 06 AMENDED PERMIT ( ) O8 MINOR CHANGE [NO SURCHARGE) <br /> I OWNER p <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) r' - JT PUBLIC AGENCY ONLY <br /> �. �(C�s q f ( l 01 FED t ] 02 STATE t ) 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 818 W. BUS. LOOP 205 TRACY CA 95376 <br /> II FACILITY <br /> FACILITY NAME DE E /FOREMAN/SUPERVISOR <br /> yrs r h/ff�rrr S>�ii u>� S Pr �1naa Pr - / <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 818 W. BUS. LOOP 205 <br /> CITY COUNTY IIP <br /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADOPESS CITY STATE ZIP <br /> 818 W. BUS. LOOP 205 TRACY CA 95376 <br /> PHONE k/AREA CODE TYPE OF 6USINESS <br /> 209-855-4301 l ) 01 GASOLINE STATION (X) 02 OTHER READY MIX CONCRETE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SlCTION <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/ARCA CODE <br /> BILL GONZALES 209-835-4301 SAME 209-838-2794 <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: 1970 C. YEAR INSTALLED 1970 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 350 GALLONS f ) 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 ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTKER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE ( ) INCHES ( ) CM l ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. (X) 01 CARBON STEEL 1 ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> t ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE f ] 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />