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STATE IC NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1X1 01 NEN PERMIT l ) 05 RENEWED PERMIT t ) 07 TANK CLOSED 1 ) 09 DELETE FROM FILE INO FEE) <br /> 1 1 OA CONDITIONAL PERMIT 1 1 06 AMENDED PERMIT 1 ) OB MINOR CHANGE (ND SURCHARGE) <br /> I OWNER <br /> NAr,E1COFRCFATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> J.C. Penney Co. , Inc. I 1 01 FED ( ) OL STATE t 1 03 LOCAL <br /> STF[ET ACnaESS CITY1n(119 <br /> 1301 Avenue of the Americas New York SNYE IF <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMEN/SUPERVISOR <br /> Firestone Store. 35Y4 Bud Porter <br /> STFEET ACO-ESS NEAREST CROSS STREET <br /> 4905 Clairmont <br /> DITttockton COUNTY San Joaquin IIP 95204 <br /> MAILING ACOPESS CITY STATE IIP <br /> PHONE W'APEA CODE TYPE OF BUSINESS <br /> 09-951-3911 [ 1 01 GASOLINE STATION [X) 02 OTHER Auto Service <br /> NUrB[P CF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> (1) One <br /> III 2/1 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: HAr,E1LAST NAME FIRST) AND PHONE W/ARCA CODE NIGHTS: HAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> Porter, Bud 209- 954-3911 - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. Xt 01 TAtRI ( 1 02 OTHER) CONTAINER NUMBER <br /> B. MAIIUFACTUP.ER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1978( ) LROCNOm <br /> D. C014TAIIIER CAPACITY: 550 GALLONS 1 ) UWNOWN E. DOES THE CONTAINER STORE: x 1 01 HASTE 1 1 02 PRODUCT <br /> F DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> 1 ) 01 UNLEADED 1 1 02 REGULAR ( ) 03 PREMIUM (. ),;09 DIESEL (X1 05 WASTE OIL t 1 06 OTHER <br /> V CONTAINER CONSTRUCTION ,.I,p ,,L.; <br /> A. TNICrtIESS OF PRIMARY CONTAINMENT: [ 1 GAUGE ( l INCHES ( ) CM 1X1 EMMNOWN <br /> IB. 1 1 01 VAULTED ILOCATED Itl Atl UNDERGROUIRI VAULT) 1 ) 02 NON-VAULTED ( X) 03 UNKNO4M <br /> IC 1 ) 01 DOUBLE WNLLED [ 1 02 SINGLE WALLED ( 1 03 LINED <br /> D. 1 1 01 CARBON STEEL [ 102 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE I 1 05 CONCRETE <br /> y 1 1 06 ALUMINUM 1 1 07 STEEL CLAD [ 1 OB BRONZE l 1 09 COMPOSITE f 1 10 NON-METALLIC <br /> P' ) 12 LRIKNOWN l ) 13 OTHER: <br /> 113004-07C185 PAGE 1 <br />