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6 NS 's`° <br /> STATE ID NUMBER 00000065391011 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED Vl 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT E ) 08 11INOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIOUAL OR PUBLIC AGENCY) FP(U <br /> BLIC AGENCY ONLY <br /> SHINKO ELECTRIC AMERICA, INC. ) 01 FED ( l 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 14701 PATRICK HENRY DRIVES BLDG SANTA CLARA CA 95054 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SHINKO ELECTRIC AMERICAl 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 STATE ZIP <br /> P.O. BOX 1208 MANTECA CA 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 ION <br /> � 3 <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 ( 1 04 OTHER: CONTAINER NUMBER T-25B <br /> B. MANUFACTURER (IF APPROPRIATED POLY CAL PLASTICS YEAR MFG: 1984C. YEAR INSTALLED 1984 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 9200 GALLONS ( ) UNKNOWN JE. 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 ( 1 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL l ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. (X) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) [ ) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED { ) 03 LINED <br /> D. { 1 01 CARBON STEEL [ 1 02 STAINLESS STEEL ( l 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE i ) 05 CONCRETE <br /> { ) 06 ALUMINUM l ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( 1 12 UNKNOWN (X) 13 OTHER: POLYETHYLENE <br /> HSC04-070185 (05/05/86) PAGE 1 <br />