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® STATE ID NUMBER 00000011082004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 0 P- ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 0 G ND IQNAL PERMIT t ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WM H. RAMSEY ( ) 01 FED t ) 02 STATE { ) 03 LOCAL <br /> STREET ADDRESS CITY ISA <br /> TATE ZIP <br /> 10501-E KIMBERLY MANTECA 95336 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> FRANK'S EXXON #3 FRANK GUINTA <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4022 HWY 120 AIRPORT <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS C%TY STATE 2IP <br /> 4022 HWY 120 MANTECA CA 95336 <br /> PHONE W/AP.EA CODE TYPE OF BUSINESS <br /> 209-239-9575 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <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 /> W.H. RAMSEY 209-239-9571 RAMSEY, W.H. 209-823-1884 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IVIV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1979 C. YEAR INSTALLED 1979 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ! ) UNKNOWN E. DOES THE CONTAINER STORE: t ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( J 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4" ( ) GAUGE (X) INCHES ( ) CM ( I UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL C ) 02 STAINLESS STEEL ( D 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> 06 ALUMINUM ( J 07 STEEL CLAD t ) 08 BRONZE ( ) 09 COMPOSITE t 110 NON-METALLIC <br /> t ) 12 UNKNOWN t ) 13 OTHER: <br /> HSC04-070105 (10/18/85) PAGE 1 <br />