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1 <br /> • • STATE ID NUMBER 00000052392001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> Vkj01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT f ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N4ME(CORPCP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY �� <br /> P G FRY PROPERTIES, INC ( ) 01 FED ( ) 02 STATE,=L.`) 03 LOCAL <br /> STREET AODPESS CITY STATE ZIP <br /> 1150 WEST CENTER ST MANTECA CA 95336 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> 1 <br /> STREET ADOPESS NEAREST CROSS STREET <br /> 735 N MAIN ST LOUISE <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 735 N MAIN ST MANTECA CA 95336 <br /> PHONE W/APEA Co t T(PE OF BUSINESS <br /> X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBEP OF CONT.4INEPSRURAL .AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LA.ST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: N.4ME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> r3 C-4en.s 7-0 51- 2 3 -F6— r <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH coR777= <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG FCYEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY:10' CY.4 GALLONS (X1 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 t l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOhN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />