Laserfiche WebLink
• • STATE ID NUMBER 00000020256002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED 1 ) 09 DELETE FROM FILE (NO FEE) <br /> ( 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> V 2- ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE A"2 <br /> P <br /> 0C �o(L IF( r5't' �� ( c Tx jo <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPVEE RRVISOR B <br /> FILL-EM'-FAST #084-04 ....n.v �` Wr• I/L/SAM'\S, <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1012 W. YOSEMITE JESSIE AVE. <br /> CITY COUNTY IIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MA:L:NO ADDRESS CITY STATE ZIP / <br /> P.O. BOX A4e67-. r <br /> PHONE W/AREA COD (� 'HYPE OF BUSINESS <br /> 6}Q-Gt3-E6I1-. ((X) 01 GASOLINE STATION ( 102 OTHER <br /> NUMBER OF CCNTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 9946 -Z'716 ' 70RO%Nt� 9A6-6ii-738& <br /> 1 -ex `7 -a 5 <br /> COMPLETE THE FOLLOWING ON A SE EACH CONTA <br /> IV DESCRIPTION <br /> A. (X) 01 TANK l l 04 OTHER: CONTAINER NUMBER 017 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1971 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 9400 GALLONS ( ) UNKNOWN E. 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 /> (X) 01 UNLEADED ( 1 02 REGULAR 1 ) 03 PREMIUM ( 104 DIESEL ( 1 05 WASTE OIL 1 ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1 1 GAUGE ( 1 INCHES 1 1 CM (X) UNKNOWN <br /> B. ( 101 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( 1 02 SINGLE WALLED f 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( l 02 STAINLESS STEEL 1 1 03 FIBERGLASS 1 ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD l 1 08 BRONZE ( 1 09 COMPOSITE l 1 30 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />