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r STATE ID NUMBER 00000011.182003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) Q EN PERMIT ( ) 05 RENEWED PERMIT I 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 1 ) 08 MINOR CHANGE (NO SURCHARGE) <br />' I OWNER <br /> NAM!fCCRPO0ATION.INOIVIDUAL OR PUBLIC AGENCY ) PUBLIC AGENCY ONLY <br /> E-Z SERVE, INC. ( 1 01 FED f 1 02 STATE ( 1 03 LOCAL <br /> STFEET ADDPESS =ABIYLENE <br /> STATE ZIP <br /> 901 SOUTH 1ST. �TX 79602 <br /> II FACILITY <br /> FACILITY NAME �IaLLjn;i-�� � DEALER/ `�HAN/SUP P,VISOR <br /> Trmrcff:i <br /> STPEET A.ODPESS NEAREST CROSS STREETI`(_Y f <br /> 952 SOUTH WILSON WAY W <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS - CITY ter, 1 STATE ZIP Q '7 f 1 <br /> P.O. BOX -5579- (J r v`t�- ! O [ ( b 1 <br /> PHONE W/AFEA CPO! TYPE OF BUSINESS <br /> 5-67 - - �j� (X) 01 GASOLINE STATION { ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NA,ME(LAST NAPE FIRST) AND PYONE W/AREA CCDE NIGHTS: NAME(LAST NAME FIRST) ANO PHONE W/AREA CODE <br /> L�E7(VERTAY - - <br /> a L <br /> c <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER.- CONTAINER NUMBER 60 <br /> B. MANUFACTURER (IF APPROPRIATE): BAGWELL YEAR MFG C. YEAR INSTALLED 78 ( f UNKNOWN <br /> I <br /> D. CONTAINER CAPACITY: 6016 GALLONS ( I UNKNOWN JE. DOES THE CONTAINER STORE. { ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES)' <br /> 1 1 01 UNLEADED (X) 02 REGULAR ( 1 03 PREMIUM f ) 04 DIESEL { 1 05 WASTE OIL I ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT; ( 1 GAUGE ( ) INCHES ( 1 CM (X) U14KNOWN <br /> S. ( 1 01 VAULTEO (LOCATED INIAt� UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN - <br /> C. ( ! 01 DOUBLE WALLED (—XX) �0�22 SINGLE WALLED I 1 03 LINED <br /> D. (X) 01 CARBON STEEL I 1 02 STAINLESS STEEL 1 6 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE { 105 CONCRETE <br /> ( ) 06 ALUMINUM I 1 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMP05ITE ( ) 10 NON-METALLIC <br /> f 1 12 UNKNOWN ( 1 13 OTHER <br /> HSC04-070185 (10/18/85) PAGE 1 <br />