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• STATE ID NUMBER 00000005737001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> CONDITIONAL PERMIT f l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> MANTECA TRAILER ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> O MANTECA CA 95336 <br /> II FACILITY 1 <br /> FACILITY NAME DEALE FOREMA /SVPERVISOR <br /> MANTECA TRAILER <br /> STREET A7DFESS1 0�� O U O NEAT CROSS STREET <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS /' D CIT <br /> MANTECA CITY STATE ZIP <br /> � - 1190 G 1 CA 95336 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-239-1267 f 1 01 GASOLINE STATION (X) 02 OTHER TRAILERS <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 1 <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 /> DAVIS BOB 209-823-3540 SAME SAM-E - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: 1974 C. YEAR INSTALLED 1974 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 3000 GALLONS f 1 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 ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS. OF PRIMARY CONTAINMENT: 10 (X) GAUGE ( ) INCHES f ) CM ( ] UNKNOWN <br /> B. t I 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> »., (X)(01 CARBON <br /> STAINLESS <br /> STEEL03 <br /> BRONZEFIBERG09SCOMPOSITE POLYVINYL <br /> 05 CONCRETE <br /> NON-METALLIC( ) <br /> 12 UNKNOWN ( ) 13 OTHER- <br /> PAGE <br /> PAGE 1 <br /> p4-070185 (10/18/85) <br />