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STATE ID NUMBER 9000001.2412002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> l 01 NEW PERMIT C ) 05 RENEWED PERMIT ( ) 07 TAW CLOSED t l 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO. SURCHARGE) <br /> I O N.N;E R <br /> NAME(COCPO'RATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> THE SOUTHLAND CORPORATION ( ) 01 FEDC ) 02 STATE t ) ;03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 5820 STONERIDOE ;MALL ROAD, *31 PLEASANTON CA 94566 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> 7-ELEVEN FOOD STORE 2243-20632 RY YOUNG <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4627 DAVINCI DRIVE MARCH MANE <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95207 <br /> MAILING ADDRESSCI?Y STATE ZIP <br /> 2937 VENEMAN ROAD MODESTO CA 95356 <br /> PHONE W/AR'EA CODE TYPE OF BUSINESS <br /> 209- (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY1T�NSMIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAM:E(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: N,AME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> TOM-EFAW 20`9-578-9716 TOM EF"AW 209-527-0870 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK t ) 04 OTHER: CONTAINER NUMBER -2 <br /> B. MANUFACTURER (IF APPROPRIATE): STOCKTON IRON WORKS YEAR MFG: C. YEAR .INSTALLED 1979 t ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN JE. DOES THE CONTAINER STORE: 'C ) O1 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 /> (X) 01;UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL E ) 05 ,WASTE OIL t ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM- (X) UNKNOWN <br /> B. ( ) 01 VAULTED fLOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. (X) 0.1 CARBON STEEL ( ) 02 STAINLESS STEEL ( l 03 FIBERGLASS- ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> t 1 06 ALUMINUM ( } 07 STEEL CLAD t Y 06 BRONZE ( ) 09 COMPOSITE t ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />