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STATE 10 NUMBER 00000011162001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ',P"ll IT 1 ) 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> € 1 q2 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( 108 MINOR CHANGE (NO SURCHARGE <br /> I OWNER <br /> NAM.E(COPFOPATION.INDIVIDUAL OR PUDLIC AGENCY) FPUBLIC AGENCY ONLY <br /> E-Z SERVE, INC. 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 901 SOUTH 1ST. ASILENE TX 79642 <br /> II FACILITY <br /> FACILITY NAPE _ �l PIDEAtER/FOP€ AN/SUPERVISOR �.�J� <br /> 3T€Ir --,4, - U_(r1 I" S C. 1 y V\ ou a.r' <br /> STREET ACOPESS NEAPEST,CROSS STPEET <br /> 952 SOUTH WILSON WAY 'ULJr <br /> CITY CCUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> P°A:LING ADDRESS CITY I STATE ZIP <br /> P.O. BOX 35?- 3c--)SD I o <br /> .PHONE W/APER CO^ �nq TYPE CF 5USINESS <br /> n 7r 1 �� 1X) 01 GASOLINE STATION 1 102 OTHER <br /> NUMBER CF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> :YS: NAME(LAST NAME FIRST) AND PHONS W/APEA CODE NIGHTS: NAME(LAST NAME FIPST) AND PHONE W/APEA CODE <br /> ckL Mk5 < < <br /> �FOLOWING ON A SEPARATE FORA FOR <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 104 OTHER' CONTAINER NUMBER 58 <br /> B. MANUFACTURER (IF APPROPRIATE): R & R YEAR MFG= C. YEAR INSTALLED 78 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 7896 GALLONS ( 1 UNKNOWN JE. DOES THE CONTAINER STORE: ( ) 01 WASTE (XI 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES)- <br /> ( ) <br /> 01 UNLEADED 1X1 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( } 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A, THICKNESS OF PRIMARY CONTAINMENT. { ) GAUGE I ? INCHES ( ) CM (X) UNKNOWN <br /> R. ( ) Cl VAULTED (LOCATED IN AN UNDERGROUND VAULT) (XI 02 NCN-VAULTED ( f 03 UNKNOWN <br /> C. ( ) 01 DCUBLE WALLED (X) 02 SINGLE WALLED 1 103 LINED <br /> D. (X) 01 CARSON STEEL ( } 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 105 CONCRETE <br /> ( ) 06 ALUMINUM i ) 07 STEEL CLAD i ) 08 BRONZE I ) 09 COMPOSITE i 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> H5C04-070185 (10/18/851 PAGE 1 <br />