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STATE ID NUMBER 00000002036002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.PCRATION.INDIVIOUAL OR PUBLIC AGENCY) _I PUBLIC AGENCY 0 LY <br /> STATE OF G�GLF�I��I[(IO"- �Recrea}/OY1 ( ) Ol FED ( 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 7800 CIENEGA ROAD HOLLISTER CA 95023 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CARNEGIE SVRA a-,► fi--FRAM ! <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 18600 CORRAL HOLLOW ROAD 10 MILES WEST OF TRACY <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> P 0 BOX 1105 TRACY CA 95376` <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 415-447-9027 ( 1 Ol GASOLINE STATION (X) 02 OTHER STATE PARK <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <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/ARCA CODE <br /> HELM, LARRY R. 408-637-8186 HELM, LARRY R. 408-637-1007 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER 02 <br /> B. MANUFACTURER (IF APPROPRIATE): BIG BOY YEAR MFG: 1983 C. YEAR INSTALLED 1984 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 SOX(ES): <br /> (X) 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: l ) GAUGE ( ) INCHES ( ) CM (X1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 02 NON-VAULTED (4"-03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED 0() 02 SINGLE WALLED ( 103 LINED <br /> 0. ( ) 01 CARBON STEEL ( 102 STAINLESS STEEL (X) 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />