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1 <br /> STATE ID NUMBER 00000049155003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> [ ) 02 CON <br /> PERMIT ( 1 06 AMEt)DEO PERMIT ( 1 08 MINOR CHANGE <br /> (NO SURCHARGE) <br /> I OWNER <br /> N.AME(CORPOPATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ( l O1 FED ( ) 02 STATE ( ) 03 LOCAL <br /> LARRY WAKSLAND <br /> - CITY STATE ZIP <br /> STREET A00PESS CA 95336 <br /> 8282 EVERITAS AVENUE MANTECA <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> LARRY WAKSLAND <br /> STREET .ACDF=SS NEAREST CROSS STREET <br /> 8282 E. VERITAS AVE. SO. MANTECA RD. <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 8282 E. VERITAS AVE. MANTECA CA 95336 <br /> PHONE 'W/APEA CODE TYPE OF BUSINESS <br /> 209-823-7124 ( 1 01 GASOLINE STATION (X) 02 OTHER AGRICULTURE RANCH <br /> NUMBER OF CONTAINERS PUPAL AREAS CNLY : TOWNSHIP RANGE SECTION <br /> 6 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> FAKSLAND <br /> S: NA�E(LAST NAME FIRST) AND PHONE W/AP.EA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/ARE.A CODE <br /> LARRY 209-823-7124 SAME " <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK [ 1 04 OTHER: CDF(TAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE) YEAR MFG 1978 C. YEAR INSTALLED 1978 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 1700 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE! ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( 1 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM [ 1 04 DIESEL ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 3/8 ( ) GAUGE (X) INCHES ( 1 CM ( 3 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED [ ) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. fX) 01 CARBON STEEL ( ) 02 STAINLESS STEEL [ 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER. <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 0 <br />