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�\." STATE ID NUMBER 00000008153003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />(*01 NEW PERMIT ( ) OS RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />HAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />(IME OIL CO. ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br />STPEET 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 />DEALEP/FOREMAN/SUPERVISOR <br />) CM ( ) UNKNOWN <br />wazolf-ST <br />0 <br />co ;L, <br />(X) 02 NON -VAULTED ( <br />B. <br />MANUFACTURER (IF APPROPRIATE): PERKINS <br />VINCENT F. BLANK <br />YEAR MFG: 1971 <br />STPEET ADDRESS <br />YEAR INSTALLED 1971 ( <br />NEAREST CROSS STREET <br />0. <br />13475 JACKTONE RD.Homey+,gt-- <br />) UNKNOWN <br />we 4 -0 -he, <br />) 01 WASTE <br />CI Y <br />F. <br />COUNTY <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL <br />ZIP <br />. LODI <br />SOX(ES): <br />WE <br />SAN JOA%UIN <br />95240 <br />MAILING ADDRESS <br />CITY <br />STATE <br />IIP <br />13475 JACKTONE RD. <br />&Ame <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 CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />IAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />iIGNIGHT. STEVEN C. 916-423-1998 SAME - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />CONTAINER <br />NUMBER 731 <br />co ;L, <br />(X) 02 NON -VAULTED ( <br />B. <br />MANUFACTURER (IF APPROPRIATE): PERKINS <br />WELDING <br />YEAR MFG: 1971 <br />C. <br />YEAR INSTALLED 1971 ( <br />) UNKNOWN <br />0. <br />CONTAINER CAPACITY: 12000 GALLONS f <br />) UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE <br />(X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />( 1 01 UNLEADED 02 REGULAR ( ) 03 <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL <br />IF YES CHECK <br />WT 06 OTHER <br />APPROPRIATE <br />44: <br />SOX(ES): <br />WE <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( <br />) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( ) 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 ( 1 <br />03 LINED <br />D. <br />fX) 01 <br />l ) <br />( ) 12 <br />CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 <br />06 ALUMINUM ( ) 07 STEEL CLAD ( ] 08 BRONZE ( 1 09 COMPOSITE <br />UNKNOWN ( ) 13 OTHER: <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/851 <br />PAGE I <br />