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STATE ID NUMBER <br /> ��—_.-- APPLICATION FOR PERMIT TO OPERATE UNDERGROUN-D STORAGE TANK <br /> ( 1 01 NEW PERMIT t ) 05 RENEWED PERMIT'-- -- -- - - <br /> [ ) 02 CONDITIONAL PERMIT f ) O6 AMENDED PERMIT t ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE [NO FEE) <br /> -- -_ ._ _� _._, - ( 1 Ol5 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER - -- - - - <br /> NAM!!COaaORATION.INCIVIDUAI 00 PUBLIC AGENCY ) - - -- -- - -- s -- --- '�— - -- _ _ <br /> PUBLIC AGENCY ONLY <br /> - -~ -ATL[ONAI—A -0I C�—CALES_�— — — c J 01 FED f 1 02 STATE ( ) 03 LOCAL <br /> STAEET PC''7RE5S — _ <br /> — IT <br /> Wilshire Blvd. CITY STATE STA, -�-- - <br /> - - - ---- — <br /> Angeles TATE zIP <br /> 90025 <br /> II FACILITY <br /> FACILITY 4411E — .___—._ - _ �---------- - <br /> OEALER/FOPEMEN>SUPEPVISOA�--�--_' - - -^ --- - <br /> I <br /> -----©ACS Af�� kiBSi i SAI=AF-- ANS -CA --- <br /> STPEEF eCC'ESS <br /> 1205 E. North Street NEAREST CPOSS STPEET <br /> �i -- Corner of Cottage St . & North St . <br /> CITY '��--__�--- <br /> ___—._—_Manteca, CA 95336 COUNTY `-`,---795336 <br /> ' - -__ <br /> - _ San Joaquin IP <br /> MAILING ADOpESS �� .._.� -- -- —. 95336 <br /> p p � �y � CITI <br /> ----'-- L�-V_.�J.Lo .--f.--.7.�_ _ 5 7 A T E <br /> - Manteca CA <br /> PHO�ME W.ACEA CODE TYPE CF BUSINESS _ <br /> (209-)---8-2 3-3 I 1 1 ( ) 01 GASOLINE STATION ( )0 0,2 OTHER <br /> NUMgEp CF CONTA I4EP5 "- <br /> PUPAL AREAS ONLY TOWNSHIP ---~��_ - <br /> --_� SECTION �- <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAr,ErLAST NAME FIPSTI AND PHONE W/ApEA COOS <br /> �� � WAIIARTIlV _.. 209 823-31 1 1 , eXt . 2223 NIGHTSa�eEf LAST NAME FIP5T 1-AND-PHONE WiAREA CODE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DU5CP, IPTIUN <br />�A, _SC 1 01 TANK t 1 02 OTHER. -- --- �.—`- ---- --- _ -- — ---_ ---- -- - _ -- �_ --- <br /> - ---- —- — - — — -- _ . -- — CONTAINER NUMBER DWT, $5 U <br /> B. MANUFACTURER (IF APPROPRIATE): Owens Corning � Ig86 <br /> ------- YEAR MFG: C. YEAR INSTALLED 1986 ( ) UNKNOWN <br /> D. C014TAI14ER CAPACITY: <br /> __ 548 GALLONS IX) UNKNDWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI O1 YES 1 J 02 1x0 <br /> ( J 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM (X) 04 DIESEL f 1 OS WASTE OIL ( ) 06 OTHER <br /> �! ^" �- - -- --ESE IF YES CHECK APPROPRIATE BOX(ES): <br /> V� CONTAINER CONSTRUCTION - ---�~— �~� - <br /> A, THICY.NESS OF PP,IMARY CONTAINMENT: ( ) GAUGE i ) INCHES ( ) CM ( ) UNKNOWN <br /> B. t 1 01 VAULTED (LOCATED IN AN UNDERGROU40 VAULT) QQ 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C, X ) 01 DOUBLE WILLED f ) 02 SINGLE WALLED [ } 03 LINED <br /> D, I 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL `XX 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE d ) 05 CONCRETE <br /> f ) Oh ALUMINUM t ) 07 STEEL CLAD ( ) 08 BRO(IZE ( ) <br /> 12 U;KNOWH 13 OTHER <br /> 09 COMPOSITE f ) 10 NON-MET <br /> ( ) ( ) <br />�!0 <br /> 07118 5 <br /> -- -- —_ ----- -- ---— ----- <br /> PAGE I <br /> OCT0 14 19$' <br />- E ROMENTAL 'HEALTH <br /> li ERiV IT/SERVICES <br />