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• . STATE ID NUMBER 00000020256003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( O1 NEW PERMIT ( I OS RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT l ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (N0 SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION./NOIVSOUAI OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> E- 5� Q RC.i ( 1 O1 FED l ) 02 STATE ( I OS LOCAL <br /> CITY STATE ZIP �O <br /> STRE[T ACDPESS A � (� � <br /> II FACILITY ✓14 J1V IJ ` <br /> FACILITY NAME DEALER/FOREMAN/SUPE RVISOR/I O <br /> FILL-EM'-FAST 0084-04 <br /> STREW ADDRESS NEAREST CROSS STREET <br /> 1012 W. YOSEMITE JESSZE AVE. <br /> COUNTY ZIP <br /> CITY MANTECA SAN JOAQUIN 95336 <br /> CITY STAT! 2I=a A �^ <br /> MAILING ADDRESS U{If <br /> P.0. BOX.EBiBT O <br /> r- <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> (X) 01 GASOLINE STATION f ) 02 OTHER <br /> NUMBER Of CONTAINERS RURAL AREAS ONLY TOWNSHIP <br /> RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAM! FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE <br /> V' I <br /> .1 X416-6.BS.32Y✓� r_ <br /> it <br /> COMPLE E THE FOLL W EACH CONTAINER w <br /> IV DESCRIPTION <br /> A. (X) 01 TANK l 1 04 OTHER: CONTAINER NUMBER 018 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1971 UtBCNOWN <br /> t ) <br /> 0. CONTAINER CAPACITY: 9940 GALLONS ( ) UNKNOWN I 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 I 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> D <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( 1 INCHES ( ) CM IX) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) O1 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> 0. (X1 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE I 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE l 1 09 COMPOSITE 1 1 30 NON-METALLIC <br /> l 112 UNKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />