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STATE ID NUMBER 00000040683001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( 07 NK CLOS f ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMEND EO PERMIT 0 MI 0 GE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPCRATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> JOHN M. BETTENCOURT f 1 01 FED f 1 D2 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 808 NO. L. STREET LIVERMORE CA 94550 <br /> II FACILITY <br /> FACILITY NAM! DEALER/FOREMAN/ <br /> COAST <br /> SUPIRVISOR <br /> COASTT COUNTIES EXPRESS D.E. WINTER T /./�T•/L/. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4131 INDUSTRIAL WAY LARCH ROAD <br /> CITY COUNTY <br /> ZIP <br /> TRACY SAN JOADUIN 95376 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 1091 TRACY CA 95376 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-835-0629 ( ) 01 GASOLINE STATION (X) 02 OTHER TRUCK TERMINAL <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAMC(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> WINTERS D.E. 209-835-0629 BURTON, GERALD 209-463-4916 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 02 <br /> S. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1971 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION c <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f 1 INCHES l ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED f 1 03 LINED <br /> D., ( ) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( 1 08 BRONZE ( l 09 COMPOSITE ( l 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />