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STATE ID NUMBER 00000000724007 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED f ) 09 DELETE FROM FILE (NO FEE) <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 /> MOORE PETROLEUM l ) 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 6TH & F ST BANTA CA 95304 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> MOORE PETROLEUM <br /> STP.EET ADDRESS NEAREST CROSS STREET <br /> 6TH 8 F ST <br /> CITY COUNTY ZIP <br /> BANTA SAN JOAQUIN 95304 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> P.O. BOX 67 BANTA CA 95304 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-835-2750 (X) 01 GASOLINE STATION [ 1 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 9 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CCDE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> MOORE, JERRY 209-948-0749 SAME SAM-E - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER= CONTAINER NUMBER 7 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: 1974 C. YEAR INSTALLED 1974 f ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 10000 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: ( l 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WAS39 OIL ? 0() 01 YES 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM W 04 DIESEL f ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( l 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 ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM C ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />