Laserfiche WebLink
a.. 14we <br /> STATE ID NUMBER 00000029861002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( l <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEEL <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> NELSON COSTA ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 6200 W. GRANTLINE R0. TRkCY CA 95376 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> NELSON COSTA <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 6200 W. GRANTLINE RD. <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 6200 W. GRANTLINE RD. TRACY CA 95376 <br /> PHONE W/AREA CODE ITYPE OF BUSINESS <br /> 209-835-1110 1 ( ) 01 GASOLINE STATION (X) 02 OTHER FARM <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAM.E(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME NAME FIRST) AND PHONE W/AREA CODE <br /> COSTA, NELSON 209-835-1110 SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. f ) 01 TANK (X) 04 OTHER: SUMP CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1970 ( ] UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE f l 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ESI: <br /> ( ) 01 UNLEADED f ) 02 REGULAR f ) 03 PREMIUM ( ) 04 DIESEL [ ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X1 UNKNOWN <br /> B. (X) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED ' <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE [ ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ! 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />