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STATE ID NUMBER 90000011242003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> NEW PER IT ( ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED — <br /> 4 TD_2__c_ojMTMNAL PERMIT ( 1 06 AMENDED PERMIT i 1 08 MINOR CHANGE (NO SURCHARGE} _ <br /> I OWNER <br /> VUBLIC AGENCY ONLY <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY] 1 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> E-Z SERVE, INC. <br /> =AII3TILENE <br /> STATL F79602 <br /> STREET ADDRESS TX <br /> 901 SOUTH 1ST. <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME , i <br /> E-7- FOOD W( ��� C� <br /> -- NEAREST CROPS STREET <br /> STPE=T ADDRESS <br /> 2537 WATERLOO ROAD <br /> xIR <br /> CITY couN Y 95205 <br /> SAN JOAQUIN �. <br /> STOCKTON <br /> CITY STATE ZIP Q <br /> MAILINa ADDRESS �� 1 <br /> 4-a ` ! <br /> P.O. Bp <br /> PHONE W/AREA rtoDE �s'� TYPE OF BUSINESS <br /> -L�7 36 (X) 01 GASOLINE STATION f i 02 OTHER <br /> NUMBER OF CONTAINERS RU�APEASONLYTOWNSHIP <br /> FAN3 aecTzoN <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAY,,S: NAME( LAST NAME FIRST) AND PHONE- W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> WEAYER AT— brL9�5�iL 1 <br /> + �I L4C <br /> � FORM FOR EAH CONTAINER <br /> COMPLETE THE LLOWING ON A <br /> IV DESCRIPTION _ <br /> A, fXl OI TANK ! ) 04 OTHER (ONTAINER NUMBER 103 <br /> YEAR MFG: C. YEAR INSTALLED 78 ( ) UNKNOWN <br /> B. MANUFACTURER (IF APPROPRIATE): JOOR --- - <br /> 0. CONTAINER CAPACITY: 9942 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE. ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f } 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED i ) 02 REGULAR ( ) 03 PREMIUM ( i 04 DIESEL [ V 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE l } INCHES I ) CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED 1 1 03 UNKNOWN <br /> C. ( 1 O1 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X){0) 06CARBON <br /> ALUMINUMSTEEL <br /> (C 1)0072STEELSTAIIICLAD STEEL <br /> 1 08(BRONZEFIBERGLASS <br /> COMPOSITE POLYVINYL <br /> NON-MCHLORIDE <br /> LLIC{ ) O5 CONCRETE <br /> ( i 12 UNKNOWN { ) 13 OTHER. <br /> — --- —— PAGE 1 <br /> HSC04-070185 (10/18/851 <br /> { <br />