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STATE ID NUMBER 00000024100002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( D 02 CONDITIONAL PERMIT ( 106 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> EXXON COMPANY U.S.A. t l 01 FED ( ) 02 STATE t J 03 LOCAL ; <br /> STREET ADDRESS CITY STATE ZIP <br /> 16945 NORTHCHASE BLVD/ HOUSTON TX 77210 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPEPVISOR <br /> EXXON SERVICE STATION MICHAEL D. COVEY <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2705 COUNTRY CLUB BLVD. <br /> CITY COUNTY ZIP <br /> STOCKTON< SAN JOAQUIN 95204 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 2705 COUNTRY CLUB BLVD. STOCKTON TX 95204 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-465-3042. (X) 01 GASOLINE STATION ( l 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 4 <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 /> HOFFMAN, S.D. 415-937-2991 HOFFMANa S.D. 415-372-3361 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION ` <br /> A. (X) 01 TANK ( ) 04 OTHER CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE) UNKNOWN YEAR MFG: 1970 C. YEAR INSTALLED 1970 ( D UNKNOWN <br /> R. CONTAINER CAPACITY: 10000 GALLONS i l UNKNOWN E. QOES THE CONTAINER STORE' t J 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 BOXtES): <br /> t D <br /> 01 UNLEADED (X) 02 REGULAR ( J 03 PREMIUM { ) 04 DIESEL t D 05 WASTE OIL t l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT ( I GAUGE ( J 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 t 103 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE t ) 05 CONCRETE <br /> ) 06 ALUMINUM ( D 07 STEEL 'CLAD ( l 08 BRONZE Y ) 09 COMPOSITE t l 10 NON—METALLIC <br /> t } 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />