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STATE ID NUMBER 00000008153002 <br />APPLICATION FOR PERMIT TO OPERATE UNDER6RnUNn STnRArW TAN(V <br />0((L 01 NEW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED f 109 DELETE FROM FILE (NO FEE1 <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 />TIME OIL CO. ( ) 01 FED f 1 02 STATE ( 1 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />2737 W. COMMODORE WAY SEATTLE WA 98199 <br />II FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER: <br />DEALER/FOREMAN/SUPERVISOR <br />) CM ( ) UNKNOWN <br />CONTAINER NUMBER 715 <br />O <br />VINCENT F. BLANK <br />MANUFACTURER (IF APPROPRIATE): PERKINS <br />STREET ADDRESS <br />YEAR MFG: 1971 <br />NEAREST CROSS STREET <br />1971 f ) UNKNOWN <br />13475 JACKTONE RD. <br />CONTAINER CAPACITY: 10000 GALLONS ( <br />-tmeF der <br />E. DOES THE CONTAINER STORE: ( ) 01 WASTE <br />CITY <br />F. <br />COUNTY <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK <br />PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL FXi 06 OTHER <br />ZIP <br />. LOOI <br />SAN JOAQUIN <br />95240 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />13475 JACKTONE RD. <br />$#}7E- !( <br />44C_ <br />95240 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-368-4381 <br />(X) 01 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERSRURAL <br />AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODA NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />HIGNIGHT, STEVEN C. 916-423-1996 SAME - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />1 GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />CONTAINER NUMBER 715 <br />Do/ <br />B. <br />MANUFACTURER (IF APPROPRIATE): PERKINS <br />WELDING <br />YEAR MFG: 1971 <br />C. YEAR INSTALLED <br />1971 f ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 10000 GALLONS ( <br />) UNKNOWN <br />E. DOES THE CONTAINER STORE: ( ) 01 WASTE <br />(X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />(X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK <br />PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL FXi 06 OTHER <br />APPROPRIATE SOX(ES): <br />%.6EMG ORBDIIRE- <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( <br />1 GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />f ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) <br />(X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />[ 1 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( 103 <br />LINED <br />D. <br />(X) 01 <br />( ) <br />( ) 12 <br />CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 <br />06 ALUMINUM ( ) 07 STEEL CLAD l 1 08 BRONZE [ 1 09 COMPOSITE <br />UNKNOWN ( ) 13 OTHER: <br />POLYVINYL CHLORIDE f ) 05 CONCRETE <br />( 1 10 NON-METALLIC <br />HSC04-070185 (10/18/851 <br />PAGE 1 <br />r <br />