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1 <br /> • • STATE ID NUMBER 00000015619001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUNDSTORAGETANK <br /> ( I <br /> 01 NEW PERMIT t ) 05 RENEWED PERMIT L(L7 TANK CLOSSp, �O Z Da ( 1 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT 1 088 MIN�GE (N SU CHARGE) <br /> I OWNER <br /> NAMECCOP,POBATION.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> TRACY RURAL FIRE DIST ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> P.O. BOX 117 <br /> Lf� BANTA CA 95304 <br /> II FACILITY <br /> EFACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> URAL FIRE DISTA0 RRESSNEAREST CROSS STREET <br /> X117 <br /> CITY COUNTY IF <br /> BANTA SAN JOAQUIN 95304 <br /> MAILING ADDRESS <br /> CITY STATE ZIP <br /> P.O. BOX 117 BANTA CA 95304 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-835-1883 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE DEPT <br /> NUMBER OF CONTAI NIPS 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 /> HUGHES, JAMES 209-836-0504 SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: 1973 C. YEAR INSTALLED 1973 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOW N E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAIN HICLE FUEL OR WASTE OIL ? (X1 O1 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 7 O1 UNLEADED (X1 02 REGULAR ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10" (X) GAUGE ( 1 INCHES ( ) CM ( l UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) Ol DOUBLE WALLED (X) 02 SINGLE WALLED ( 7 03 LINED <br /> D. (X) 01 CARBON STEEL ( l 02 STAINLESS STEEL ( l 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM [ 1 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN f 1 13 OTHER: <br /> PAGI <br /> HSC04-070185 (10/18/85) <br />