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zhaj <br /> • STATE ID NUMBER 00000031202003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 91 NEW PERMIT ( l 05 RENEWED PERMIT OCf 07 TANK CLOSED 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( l 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATIO ,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> wa-em-6i-t£B. t l 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 02/ CA 114x1 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> UNION OIL SS #5417 JAMES J. MC CARTHY <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1700 EAST YOSEMITE AVE. HWY 99 <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS CITY 7CA <br /> TE IIP <br /> ,'Q ;—r"" � ,ZS/1{� t gAN�E�*- 4i33r6� <br /> PHONE W/AP.EA CODE TYPE 0 BUSINESS <br /> 209-239-4398 (X) 01 GASOLINE STATION ( l 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <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 /> JAURIGUI, L.J. 415-9&6-T&H f y UNION OIL CO. 415�ib EtrQ ';� <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 5411-44-1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 280 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 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 ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION A <br /> A. THICKNESS OF PRIMARY CONTAINMENT: t ) GAUGE ( l INCHES ( ) CM (X) 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 ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 105 CONCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> l 12 UNKNOWN ( ) 13 OTHER= <br /> HSC04-070185 (10/18/85) PAGE 1 <br />