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• STATE ID NUMBER 00000011196001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />MIT 1 1 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br />1 02 GOND ITI AL PERMIT f 1 06 AMENDED PERMIT ( 1 OB MINOR CHANGE fN0 SURCHARGE) <br />I OWNER <br />NAMf(C ORPORAT ION.IN" IVIDUAL OR PUS LID AOC NCYI PUBLIC AGENCY ONLY <br />E-2 SERVES INC. f 1 O1 FED ( 1 02 STATE f 1 03 LOCAL <br />STFlFT ADDRCSS CITY STATE ZIP <br />901 SOUTH 1ST. ABILENE TX 79602 <br />EII FACILITY <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 OTHER: <br />f 1 GAUGE l 1 INCHES 1 <br />CONTAINER NUMBER 61 <br />B. <br />MADSEN'S SUNRISE DAIRY <br />YEAR MFG: <br />DEAL ER/F OR EAN/SUPERVISOR <br />D. <br />/Ofi.Q�L0. <br />E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X1 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />( 1 01 UNLEADED (XI 02 REGULAR ( )03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f 1 06 OTHER <br />D. <br />(X) 01 <br />( ) <br />( 112 <br />STREET ADDRESS <br />1 03 FIBERGLASS ( 1 04 <br />BRONZE ( 1 09 COMPOSITE <br />NEAREST CROSS <br />STPEFT <br />239 SOUTH STOCKTON <br />C <br />CITY <br />_ <br />RIPON <br />COUNTY <br />IIP <br />SAN JOAQUIN <br />95366 <br />MAILING ADDRESS <br />CITY <br />P.O. BOX 25;9 3 S C.J. O <br />STATE <br />IIP <br />0. <br />PHONE W/APER COD�"""""_ <br />T l'Pf OF BVSINfSS <br />-_. ==a��-.-_•----.. <br />qt5'6t="PBZ" <br />^�J7� <br />IX) 01 GASOLINE STATION 1 l 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY : <br />TOWNSHIP <br />RANGE <br />SECTION <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/APIA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />NErtVEiTi 7( WEAVEit-r-R#i`- 6:; S61 lit3i- <br />7 B <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EAC <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />f 1 GAUGE l 1 INCHES 1 <br />CONTAINER NUMBER 61 <br />B. <br />MANUFACTURER (IF APPROPRIATE): R E R <br />YEAR MFG: <br />C. YEAR INSTALLED 78 ( 1 UNKNOWN <br />D. <br />CONTAINER CAPACITY: 7896 GALLONS ( 1 UNKNOWN <br />E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X1 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />( 1 01 UNLEADED (XI 02 REGULAR ( )03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f 1 06 OTHER <br />IV CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: <br />f 1 GAUGE l 1 INCHES 1 <br />I CM (X) UNKNOWN <br />B. <br />( 1 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />1 03 UNKNOWN <br />C. <br />( 1 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED f <br />1 03 LINED <br />D. <br />(X) 01 <br />( ) <br />( 112 <br />CARBON STEEL ( 1 02 STAINLESS STEEL f <br />06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 <br />UNKNOWN ( ) 13 OTHER: <br />1 03 FIBERGLASS ( 1 04 <br />BRONZE ( 1 09 COMPOSITE <br />POLYVINYL CHLORIDE f 1 05 CONCRETE <br />( 1 10 NON-METALLIC <br />70165 (10/18/85) <br />is 0 <br />PAGE 1 <br />