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11 A <br /> O�e[,�e D �3 � STATE ID NUMBER 00000065391008 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f } 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED r>4 09 DELETE FROM FILE (En FEE) <br /> ( ) 02 CONDITIONAL PERMIT i } 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SHINKO ELECTRIC AMERICA, INC. ( ) 01 FED ( 1 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITY jcsA <br /> TATE ZIP <br /> 4701 PATRICK HENRY DRIVE, BLDG SANTA CLARA 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 STATE ZIP <br /> P.O. BOX 1208 MANTECA CA 95336 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-239-6559 ( } 01 GASOLINE STATION (X) 02 OTHER MANUFACTURING <br /> NUMBER OF CONTAINERS RURAL AREAS ONLYTOWNSHIA TRANGE SECTION <br /> 16 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> PAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAMEfLAST NAME FIRST) ANO PHONE W/AREA CODE <br /> IBUETTNER, 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-22 <br /> B. MANUFACTURER (IF APPROPRIATE): POLY CAL PLASTIC YEAR MFG= 1984 C. YEAR INSTALLED 1984 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 7200 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 ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 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. ( ) 01 CARBON STEEL [ 102 STAINLESS STEEL [ l 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ) 06 ALUMINUM I ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE I l 10 NON-METALLIC <br /> ( ) 12 UNKNOWN (X) 13 OTHER: POLYETHYLENE <br /> HSC04-070185 (05/05/86) PAGE 1 <br />