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• STATE ID NUMBER 00000018913003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (X 01 NEW PERMIT ( ) 05 RENEWED PERMIT f l 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> I[NAME(COPPORATIONN,IKDIVIDUAL OR PUBLIC AGENCY) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> ME OIL CO. <br /> CITY STATE ZIP <br /> REET ADDRESS SEATTLE WA 9819937 W. COMMODORE WAY <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME VINCENT F. BLANK <br /> .B -MART <br /> NEAREST CROSS.STREET <br /> STREET ADDRESS VINYARD AVE. <br /> 1554 W. YOSEMITE <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 95336 <br /> MANTECA <br /> CITY n� ( SLAT! ZIP <br /> MAILING YOSEMITE `/} 95336 <br /> 1554 W. YOSEMITE <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-239-1792 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS <br /> 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 /> HIGNIGHT, STEVEN C. 916-423-1998 SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: <br /> CONTAINER NUMBER 476 <br /> B. MANUFACTURER (IF APPROPRIATE): MODESTO WELDING YEAR MFG: 1973 C. YEAR INSTALLED 1973 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f ] 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> UQ 01 UNLEADED t*4 02 REGULAR ( 1 03 PREMIUM ( 1 04 DIESEL ( 1 05 WASTE OIL *06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES f ) CM ( l UNKNOWN <br /> B. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ] 03 LINED <br /> D. (X) 01 <br /> CARBON <br /> ALUMINUM STAINLESS <br /> STEEL 08( 03 BRONZEF IBERG09SCOMPOSITE POLYVINYL11005 CONCRETE <br /> NON-METALLIC( 1 <br /> ( ) 12 UNKNOWN ( 1 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br /> i � <br />