Laserfiche WebLink
0 <br /> APPLICATION FOR <br /> ( ) O1 NEW PERMIT PERMIT 70 OPER vile STATE ID NUMBER <br /> �02 CONDITIONAL PERMIT E UNDERGROUND 00000038515002 <br /> ( ) 05 RENEWED PERMIT STORAGE <br /> f ) 06 AMENDED PERMIT ' TANK <br /> MINOR CHANGE <br /> I (NO SURCHARGE) 'D 09 D <br /> 08 ELETE FROM FILE (NO FEE) <br /> NAME(COpPO <br /> INDIVIDUAL OR PU <br /> J BLIC AGENCY) <br /> STREET ADDRESS U�N G��STREET PUBLIC AGENCY ONLY <br /> '""'I:�MAIN ( ) <br /> CITY O1 FEO <br /> ( ) 02 STATE ( ) 03 LOCAL <br /> II FACILITY MANT*EA STATE ZIP <br /> CAzw <br /> 95336 <br /> FACILITY NAME ==7, <br /> JIM T <br /> d� ICN �� /ADEALER/FOREMAN/S <br /> STPEET ADDPESS 'I UPERVISOR ) <br /> MAIN STREET G LIf VjN C, 7✓ <br /> YOSEMITE <br /> NEAREST CROSS STREET <br /> _ <br /> MANTECA <br /> COUNTY <br /> )'ell:%+ ADDPESS SAN JOAQUIN ZIP <br /> MAIN STREET CITY 95336 <br /> _CCIE MANTENCA STATE ZIP <br /> P <br /> TYPE OF BUSINESS CA 95336 <br /> O — 3 2-Y ( ) OS GASOLINE STATION (X) 02 OTHER CAR DEALER <br /> 6GMSER OF C--NTAINERS RURAL AREAS ONLY ; <br /> 2 TOWNSHIP <br /> RANGE <br /> SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME F=PST) ANC -Cl_ : 4;EA CODE <br /> AF-I, . 209-1 NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> �l 3-332y <br /> 209-823wll*r 33Z <br /> CDMPLETE THE FOLLOWIIG ON A SEPARATE FORM FOR EAC CONTAINER <br />:V DESCRIPTION <br /> 1. (X) 01 TANK f l 04 OTHER: <br /> CONTAINER NUMBER 123 <br /> I. MANUFACTURER (IF APPROPRIATE): <br /> YEAR MFG: C. YEAR INSTALLED <br /> (X) UNKNOWN <br /> I. CONTAINER CAPACITY: 500 GALLONS l UNKNOWNE. DOES THE CONTAINER STORE: ( ) O1 WASTE (X) 02 PRODUCT <br /> DOES THE CONTAINER STORE MOTOR VEHICLE FL OR WASTE OIL ? (X) O1 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 EMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> CONTAINER CONSTRUCTION <br /> THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES f ) CM (X) UNKNOWN <br /> f ) 01 VAULTED (LOCATED IN AN UNDERGROUNOULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> ( ) 01 DOUBLE WALLED f ) 02 SINGLE WALLET ) 03 LINED <br /> 01 CARBON STEEL f ) 02 STAINLESS STEP; ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( )BRONZE OS CONCRETE <br /> ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> 5004-070185 (10/18/85) <br /> PAGE 1 <br />