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mia Po <br /> o STATE ID NUMBER 00000065391010 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( 1 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED 09 DELETE FROM FILES FEE, <br /> ( ) 02 CONDITIONAL PERMIT ( , 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) �' <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) JP(u <br /> BLIC AGENCY ONLY <br /> SHINKO ELECTRIC AMERICA, INC. ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 4701 PATRICK HENRY DRIVE, BLDG SANTA CLARA CA 95054 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SHINKO ELECTRIC AMERICA, INC. K. KOBAYASHI <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 551 CARNEGIE STREET <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS CITY <br /> rC <br /> E LIP <br /> P.O. BOX 1208 MANTECA 95336 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-239-6559 ( ) 01 GASOLINE STATION (X) 02 OTHER MANUFACTURING <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 15 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> BUETTNER, BILL 209-239-6559 BUETTNER, BILL 209-524-9809 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER T-25A <br /> B. MANUFACTURER (IF APPROPRIATE): POLY CAL PLASTIC YEAR MFG: 1484 C. YEAR INSTALLED 1984 1 ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 9200 GALLONS i ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL I l 05 WASTE OIL 1 ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES i 1 CM ( 1 UNKNOWN <br /> B. (X) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED i ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS i l 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM { 1 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN (X) 13 OTHER: POLYETHYLENE <br /> HSC04-070185 (05/05/86) PAGE 1 <br />