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• • STATE ID NUMBER 00000020256001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 NEW PERMIT f ] 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE IND FEE) <br /> ( ') 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE INO SURCHARGE) <br /> I OWNER <br /> NAMEICORPORATION.INDIVIDUAL OR PUBLIC A CNCYI PUBLIC AGENCY ONLY <br /> E-'Z2.r(J� �/\,L ( 1 Ol FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDPESS CITY STATE ZIP <br /> FI rs+ rna>•o-- b TX �Bexe-�q60 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR O���' <br /> FILL-EM'-FAST 11084-04 RANQ* M�SPLE, f `�G-1'YLJ <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1012 W. YOSEMITE JESSIE AVE. <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS �7 CITY STATE ZIP <br /> P.O. BOX e0e6fSAN_AMTORIIT -1 p r 1 (J T* C.{+ ;Saeo <br /> PHONE W/APEA CO E ^ G�-L TYPE OF BUSINESS <br /> ilY-2Z3+443i d+�l� ` `� (XI 01 GASOLINE STATION f 1 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLYTOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APIA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JDADAHt-dkR1'- ;av-�rc7 o- JGRQA lr.GAR*— -916 6"6 <br /> - <br /> CMPLE E THE FOOLLOWING ON A SEPARATE FORM FOR EACH CON <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: =CONTAINER NUMBER 016 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1971 f l UNKNOWN <br /> D. CONTAINER CAPACITY: 9940 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 1 ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> l 1 01 UNLEADED 1 1 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL l ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES l ) CM (XI UNKNOWN <br /> B. 1 I 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (XI 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. 1 1 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f 1 03 LINED <br /> D. 1X1 01 CARBON STEEL ( 1 02 STAINLESS STEEL f 1 03 FIBERGLASS f 1 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD 1 1 08 BRONZE ( 1 09 COMPOSITE 1 1 10 NON-METALLIC <br /> 1 1 12 UNKNOWN f 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />