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• • STATE ID NUMBER 00000011196002 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />(j) 01-UE{LPERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />( 1 02 CONDI IONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br />L Vn.11I <br />NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />E -Z SERVE, INC. ( ) 01 FED ( l 02 STATE ( 1 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />901 SOUTH 1ST. ABILENE TX 79602 <br />I 1 1n11 I, . . <br />UCOI.RariaV.� <br />DEALER/FOPEMAN/SUPERVISOR 6 <br />FACILITY NAME <br />CONTAINER <br />MADSEN'S SUNRISE DAIRY <br />B. <br />4- <br />STREET ADOPESS <br />C. <br />NEAREST CROSS STREE <br />239 SOUTH STOCKTON <br />CONTAINER CAPACITY: 7896 GALLONS ( ) UNKNOWN <br />E. DOES THE <br />CONTAINER STORE: ( <br />1 01 WASTE (X) 02 PRODUCT <br />dOUNly <br />ZIP <br />CITY <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( 1 06 OTHER <br />SAN JOAQUIN <br />95366 <br />RIPON <br />MAILINO AODPESS <br />CITY /� -C <br />STATE <br />ZIP <br />7Ai-0Ar•i i <br />P.O. BOX-3•JT4^ '� rJ SO <br />L rj4v__ <br />0 <br />PNCNf Wi AP[• CO^�E ��� _ �G <br />9Y5-6.IZr.6Y8Y P`n��`�(n` 3 -IV <br />TYPE OF BUSINESS <br />(X1 01 GASOLINE STATION ( 102 OTHER <br />NUMBER OF CONTAINERS <br />RVRAL <br />AREAS ONLY : <br />TOWNSHIP <br />PANOE <br />SECTION <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />CAYS: NAM!(LAST NAME FIRST) AND PHONE W/AREA CODE <br />14 / "( D"I- <br />NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />bThMEA._R.AY—ez T+.L 17� <br />1V <br />UCOI.RariaV.� <br />A. <br />(X) 01 TANK ( 1 04 OTHER: <br />CONTAINER <br />NUMBER 62 <br />B. <br />MANUFACTURER (IF APPROPRIATE): R i R <br />YEAR MFG: <br />C. <br />YEAR INSTALLED 78 1 ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 7896 GALLONS ( ) UNKNOWN <br />E. DOES THE <br />CONTAINER STORE: ( <br />1 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X1 <br />(X) 01 UNLEADED ( 1 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL <br />01 YES ( 1 02 NO <br />( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( 1 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. THICKNESS OF PRIMARY CONTAINMENT: ( I GAUGE ( 1 INCHES ( ) CM 1X1 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 ( 1 03 LINED <br />0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br />( ) 06 ALUMINUM ( ) 07 STEEL CLAD 1 108 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br />( ) 12 UNKNOWN ( 1 13 OTHER: <br />PAGE 1 <br />HSC04-070185 (10/18/85) <br />O <br />