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t <br /> STATE ID NUMBER 04000049155004 <br /> (' APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> Ft ) 01 NEW PER ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> t 1 02 CONDITIONAL PERMIT [ 1 O6 AMENDED PERMIT E ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWN ER <br /> ��PUBLICY ONLY <br /> NAME(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) ( 1 02 STATE f ) 03 LOCAL <br /> LARRY WAKSLAND <br /> CITY STATE ZIP <br /> STREET ADDRESS MANTECA ICA 95336 <br /> 8282 EVERITAS AVENUE <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME <br /> LARRY WAKSLAND <br /> NEAREST CROSS STREET <br /> STREET ADDRESS 50. MANTECA RD. <br /> 8282 E. VERITAS AVE. <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 95336 <br /> MANTECA <br /> CITY STATE ZIP <br /> MAILING ADDRESS MANTECA CA 95336 <br /> 8282 E. VERITAS AVE. <br /> FF(CNE W/AREA CODE TYPE OF BUSINESS <br /> 249-823-7124 t ) O1 GASOLINE STATION (X) 02 OTHER AGRICULTURE RANCH <br /> c RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> NUMBER OF CONTAIN-PS <br /> 6 �: <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> EAKSLANOLARRY <br /> ME(LAST�NAM=_= FIRST) .4 ND PHONE W/AREA CCDE NIGHTS: NAME(LAST NAME FIRST)-AND-PHONE W/ARE.A CODE <br /> 209-823-7124 SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. tX1 01 TANK ( ) 04 OTHER CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG:�YEARLED 1978 ( l UNKNOWN <br /> D. CONTAINER CAPACITY: 1700 GALLONS ( 1 UNKNOWN JE. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? t ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES1: <br /> ( ) 01 UNLEADEO ( ) 02 REGULAR ( ) 03 PREMIUM l ) 04 DIESEL [ 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION ° <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 3/8 t ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. i 1 01 VAULTED ( LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON—VAULTED ( ) 03 UNKNOWN <br /> C. t ] of DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> O. d l`0) CARBON <br /> STAINLESS <br /> STEEL <br /> 08(BRONZEFIBERGLASS1COMPOSITE POLYVINYL <br /> NON-MET45 CCONCRETE <br /> 03 ALLICIDEt 1 <br /> f 1 12 UNKNOWN [ l 13 OTHER: <br /> — PAGE 1 <br /> HSC04-070185 (10/18/85) <br />