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STATE ID NUMBER 00000012412003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 41 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( J 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT { 106 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDU.AL OR PUBLIC AGENCY) T(UB)L <br /> IC AGENCY ONLY <br /> THE SOUTHLAND CORPORATION 01 FED ( ) 02 STATE t ) 03 LOCAL <br /> STPtET ADDRESSCITY STATE 794566 <br /> IP <br /> 5820 STONERIDGE MALL ROAD. #31 PLEASANTON CA <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> 7-ELEVEN FOOD STORE 2243-20632 MARY Y906 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4627 DAVINCI DRIVE MARCH LANE <br /> CITY COUNTY ZIP <br /> STO KTON SAN JOAQUIN 95247 <br /> MAILING ADDRESS ___]CITY STATE ZIP <br /> 2937 VENEMAN ROAD MODESTO CA 95356 <br /> PHONE W/AREA CO-Df, TYPE OF BUSINESS <br /> 2II9- C (X) 01 GASOLINE STATION f ) 02 OTHER <br /> NUMBER OR CONTAINERS RURAL AREAS ONLY :]T�NSMTP RANGE SECTION <br /> 3' <br /> III 24 HOUR EMERGENCY CO>NT,ACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> TOM;EFAW 209-578-9716 TOM EFAW 209-527-0870 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (:X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): STOCKTON IRON WORKS YEAR MFG: C. YEAR INSTALLED 1979 ( I UNKNOWN ` <br /> D. CONTAINER CAPACITY: 10000 GALLONS t D UNKNOWN E. DOES THE CONTAINER STORE: t D 01 WASTE (:X) 02 PRODUCT <br /> F. DOES T44E CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 02 ,NO TF YES CHECK APPROPRIATE BOX(ES): <br /> f l 01 UNLEADED t ) 0t REGULAR (X) 03 PREMIUM ( J 04 DIESEL. { ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAIk,ER COAST -U.CTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( D GAUGE ( J INCHES ( ) CM (X) UNKNOWN <br /> B. # l 01 VAULTED {LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED t D 03 UNKNOWN <br /> C. ( l 41 DOUBLE WALLED (X) 02 SINGLE WALLED t l 03 LINED <br /> D. (<X) 01 CARSON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( l 05 CotickETE <br /> C ) 06 ALUMINUM t ) 07 STEEL'CLAD ( ) 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> l 12 'UNKNOWN { } 13 OTHER <br /> HSC04-07018-5 (10/18/85) PAGE 1 <br />