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• STATE ID NUMBER 00000052392003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (>O 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 4-J6-02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N4NE(COP,PCPATION.:ND:V:DUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> P G FRY PROPERTIES, INC ( 1 01 FED ( l 02 STATE ( 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1150 WEST CENTER ST MANTECA CA 95336 <br /> II FACILITY <br /> FACILITY NAME / DE.ALER/FOREMAN/SUPERVISOR <br /> RT <br /> N <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 735 N MAIN ST LOUISE <br /> _TY 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 CODE TYPE OF BUSINESS <br /> 209-2'-39'1-75 r- 23�_�6y3 (X) 01 GASOLINE STATION ( l 02 OTHER <br /> ANGE ON <br /> NUMBER. OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RSECTI <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AP.E.A CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> JAV� nAc Eis,Nyx-05 - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION p <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY GALLONS (X) 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 ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 02 REGULAR ( l 03 PREMIUM ( l 04 DIESEL ( l 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 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. ( l 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />