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0 <br />0 STATE ID NUMBER 00000006224004 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />P ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />( ) 02 C NDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />!NAMS(CORPOR,ATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />QUIK STOP MARKETS INC ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br />STREET ADDRESSCITY STATE ZIP <br />4567 ENTERPRISE JFREMONT ICA 94538 <br />II FACILITY <br />FACILITY NAME <br />tX) 01 TANK ( ) 04 OTHER: <br />DEALER/FOREMAN/S PERVISOR <br />CONTAINER <br />QUTK STOP #120 <br />A. <br />B. <br />MANUFACTURER (IF APPROPRIATE): XERXES <br />STREET ADDRESS <br />C. <br />NEAREST CROSS STREET <br />) UNKNOWN <br />9321 N. THORNTON RD <br />CONTAINER CAPACITY: 8000 GALLONS ( l UNKNOWN <br />WAGNER HEIGHTS <br />) 01 WASTE (X) 02 PRODUCT <br />CITY <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 02 NO <br />( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL C <br />COUNTY <br />BOX(ES): <br />ZIP <br />STOCKTON <br />POLYVINYL CHLORIDE f ) 05 CONCRETE <br />SAN JOAQUIN <br />( ) <br />95207 <br />MAILING ADDRESS <br />( ) 10 NON-METALLIC <br />CITY <br />STATE <br />ZIP <br />PO BOX 5745 <br />FREMONT <br />CA <br />94537 <br />PHONE W/APE.A CODE <br />TYPE OF BUSINESS <br />209-478-7149 <br />(X) 01 GASOLINE STATION t D 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />111 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(L.AST NAME FIRST) AND PHONE W/AREA CODE <br />G y 49 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />tX) 01 TANK ( ) 04 OTHER: <br />CONTAINER <br />NUMBER 145 <br />A. <br />B. <br />MANUFACTURER (IF APPROPRIATE): XERXES <br />YEAR MFG: <br />C. <br />YEAR INSTALLED 1983 t <br />) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 8000 GALLONS ( l UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 02 NO <br />( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL C <br />IF YES CHECK APPROPRIATE <br />) 06 OTHER <br />BOX(ES): <br />V CONTAINER CONSTRUCTION <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: <br />( ) GAUGE t ) INCHES ( <br />) CM (X) UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED t <br />) 03 LINED <br />D. <br />( ) 01 <br />CARBON STEEL ( ) 02 STAINLESS STEEL <br />(X) 03 FIBERGLASS { ) 04 <br />POLYVINYL CHLORIDE f ) 05 CONCRETE <br />( ) <br />06 ALUMINUM E ) 07 STEEL CLAD • ( ) 08 <br />BRONZE t ) 09 COMPOSITE <br />( ) 10 NON-METALLIC <br />) 12 <br />UNKNOWN ( ) 13 OTHER; . <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />