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I <br /> jG Qi�OV�� fir+ <br /> STATE ID NUMBER 00000024703001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 ) O1 NEW PERMIT ( ) 05 RENEWED PERMIT (Y) 07 TANK CLOSED [ 1 09 DELE ROM FILE (NO FEEL <br /> E 1 02 CONDITIONAL PERMIT [ ) 06 AMENDED PERMIT INOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N.A`lE(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> FRANKLYN J. WARREN, SR. ( ) 01 FED ( 1 02 STATE [ ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 6006 E LATHROP RD MANTECA CA 95336 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> WARREN <br /> STE"e ET ADDRESS NEAREST CROSS STREET <br /> 6006 E LATHROP RD 99 FRONTAGE <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS CITY A]CTA4 <br /> TE IIP { <br /> 6006 E LATHROP RD MANTECA 95336 <br /> F}fCNE W/AREA COOS TYPE OF BUSINESS <br /> 209-239-2696 ( ) 01 GASOLINE STATION (X) 02 OTHER COMMERCIAL BLDG <br /> Nl1M9ER OF CONTAINERS RURAL AREAS ONLYTOWNSHIP RANGE SECTION <br /> 1 <br /> I1I 24 HOUR EMERGENCY CONTACT PERSON <br /> OAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> WARREN, FRANKLYN J. 209-239-2696 SAME — — <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER i <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: GALLONS (X) UNKNOWN I E. DOES THE CONTAINER STORE: ( ) 01 WASTE ( ) 02 PRODUCT <br /> F. HOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? f ) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR t ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) (UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON—VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( 1 03 LINED <br /> 0. ( 1 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE f ) 09 COMPOSITE ( ) 10 NON—METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 1 <br /> .. 'a _— - -_..-rte u .�.+— _ r-r _. .. .� ✓: <br />