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STATE ID NUMBER 00000004252001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> fK 01 NEW PERMIT f 1 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( 106 AMENDED PERMIT ( 7 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION.INDIVIDUAL OR PUBLIC AGENCY) \ A PUBLIC AGENCY ONLY <br /> GLASROCK HOME HEALTH CARE �'�`{,� {�a(�:'<C 6f4L 1`�/4�� p °�F l -'f 6 `f}p( '( 7 01 FED ( ) 02 STATE f 1 03 LOCAL <br /> STREET A.DCPESS7� + CITY ,J' STATE ZIP <br /> 765--11laWSM *t-PARK-0R , .� /_7r )�C. �.�u L ¢ i MANXEC1 Sf�:'.:aF:f. r41 CA !� <br /> II FACILITY V' ,/p� ma^ <br /> FACILITY NAME DEALER/FOREMAN/SUPERVI$ bR � <br /> GLASROCK HOME HEALTH CARE <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 705 INDUSTRIAL PARK DR BESSEMER <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 705 INDUSTRIAL PK DR MANTECA CA 95336 <br /> PHONE W/ARCA CODE TYPE OF BUSINESS <br /> 209-239-4106 (X) 01 GASOLINE STATION f ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <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 /> DAVID HEATH 209-239-4106 DAVID HEATH 209-823-6452 <br /> (� COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): STOCKTON MAN YEAR MFG:7C. YEAR INSTALLED 1980 ( ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 2000 GALLONS f l UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X1 02 PRODUCT <br /> F. DOES THE CONTAINER TORE MOTOR VEHICLE FUEL OR WASTE OI.L ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br /> f ) 01 UNLEADED 02 REGULAR f 7 03 PREMIUM ( ) 04 DIESEL f 7 05 HASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE [ 1 INCHES ( ) CM (X) UNKNOWN <br /> B. l 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( l 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( 1 02 SINGLE WALLED [ ) 03 LINED <br /> D. ( ) 01 CARBON STEEL f 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> f ) 06 ALUMINUM f ) 07 STEEL CLAD f ) 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br /> 11/ '14a tiI <br />