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STATE ID NUMBER 00000012406003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT 05 RENEWED PERMIT ( ) j(' ] 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT (�) 08 MANK CCHANGE 09 DELETE FROM FILE [NO FEET <br /> �NO�SURCHkRGE)1 <br /> I OWNER <br /> NAME(CORPORATION,:NDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> THE SOUTHLAND CORPORATION ( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 5820 STONERIDGE MALL ROAD, 031 PLEASANTON CA 94566 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> 7-ELEVEN FOOD STORE 2243-20304 ALFRED i BETTY PENA <br /> STPEET ADDRESS NEAREST CROSS STREET <br /> 455 GRANTLINE BUTHMAN <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2937 VENEMAN ROAD MODESTO CA 95356 <br /> PHONE W/AP.EA CODE TYPEOF BUSINESS <br /> 209-578-9716 (X1 01 GASOLINE STATION ( ] 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 /> TOM EFAW 209-578-9716 TOM EFAW 209-527-0870 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER t4304-3 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG:- <br /> C. YEAR INSTALLED 1978 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 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 f ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE 1 ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> 0. (.XI 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ] 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 112 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> %mv <br />