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STATE ID NUMBER 00000003443007 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 0 <br /> 1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> R. E. DEGNAVEL ( ) 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> P. 0. BOX 1376 LA MESA CA 920410210 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOR MAN/SUPERVISOR <br /> CARNIEGIE AUTO/TRUCK PLAZA <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3. CORRAL HOLLOW RDo <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 1 95376 <br /> MAILING ADDRESS CITY STATE ZIP <br /> S. CORRAL HOLLOW RD TRACY CA 95376 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-836-3805 (X) 01 GASOLINE STATION E ) 02 MER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 8 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(`LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONES WW//AREA CODE <br /> 209-836-3805 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 7 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 12000 GALLONS [ l UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 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 /> ( ) 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( l 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( 7 CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 02 NON-VAULTED (-)C1'03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED f 1 02 SINGLE WALLED ( 1 03 LINED <br /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> l ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE f l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />