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STATE ID NUMBER $0000006249002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW P OMIT ( D 05 RENEWED PERMIT ( ) 07 TAW>CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> C ) 02 CONDITIONAL PERMIT ( 3 '06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) - PUBLIC AGENCY ONLY <br /> QUIK STOP MARKETS IRC t D 01 FED t ) 02 STATE ( D 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 4567 ENTERPRISE FREt1ONT CA 94538 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUP RVISOR //� <br /> QUIK STOP MKT #76 'mirex `l2 r <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1030 S OLIVE MAIN <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE ZIP <br /> PO BOX 5745 FREMONT CA 94537 <br /> PHONE W!APEA CODE TYPE OF BUSINESS <br /> 209-948-6731 (X) 01 GASOLINE STATION t } 02 OTHER <br /> NUMBER OF CONT A!NEPS RURAL AREAS ONLYTOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST Y AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 1 E 0 ,�:' G> <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 49 <br /> B. MANUFACTURER (IF APPROPRIATE) TEAR MFG: C. YEAR INSTALLED 1973 t ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN JE. 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 /> t ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION- <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE " ( D 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 SINGLEWALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS 4 } 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> t ) 06 ALUMINUM t )' 07 STEEL CLAD ( ) 08 BRONZE C ) 09 COMPOSITE t ) 10 NON-:METALLIC <br /> 12 UNKNOWN C. D 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />