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STATE ID NUMBER 00000058144001 <br /> APP.IICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 0j) 01 NEW PERMIT l 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> •f f•02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATiON.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY / <br /> MANTECA-LATHROP RURAL pneo-mo-O&L A ( ] 01 FED ( ) 02 STATE f ) 03 LOCA <br /> STREET ADDRESS CITY STATE ZIP <br /> 9121 E. LATHROP RD. MANTECA CA 95336 <br /> II FACILITY <br /> FACILITY NAME r`l DEALER/FOREMAN/SUPERVISOR <br /> MANTECA-LATHROP RURAL PME-B35 Mtk( rA r7ont,� JIM ENNES <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 7121 E. LATHROQRD. AUSTIN ROAD <br /> COUNTY ZIP <br /> CITY95336 <br /> MANTECA SAN JOAQUIN <br /> MAILING 40OPESS CITY STATE Zip <br /> P.O. BOX 151 MANTECA CA 95336 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-982-5170 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE DEPT. <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 /> ENNES, JAMES 209-982-5170 SAME - r7o <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) Ol TANK ( ) 04 OTHER: CONTAINER NUMBER 001 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1975 C. YEAR INSTALLED 1975 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 350 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOXt ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE ( ) INCHES ( ) CM f l UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ) 03 LINED <br /> D. (X) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD f ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( 1 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br /> . i � <br />