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STATE ID NUMBER 00000012661003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />OC) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />4 02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />THE SOUT41LAND CORPORATION ( ) 01 FED ( 7 02 STATE ( ) 03 LOCAL <br />STREET ADORESS CITY STATE ZIP <br />5820 STONERIDGE MALL ROAD, #31 PLEASANTON CA 94566 <br />II FACILITY <br />FACILITY NAME <br />THICKNESS OF PRIMARY CONTAINMENT: <br />DEALER/FOREMAN/SUPERVISOR <br />( ) INCHES ( <br />7 -ELEVEN FOOD STORE 2243-14117 <br />B. <br />HARMOHAN SOHI <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 <br />STREET ?CDPESS <br />) 03 UNKNOWN <br />NEAREST CROSS STREET <br />( ) 01 <br />2725 COUNTRY CLUB BLVD. <br />7 03 LINED <br />INTERSTATE 5 <br />CITY <br />(X) 01 <br />( ) <br />( J 12 <br />'COUNTY <br />( ) 03 FIBERGLASS ( ) 04 <br />BRONZE f ) 09 COMPOSITE <br />ZIP <br />STOCKTON <br />SAN JOAQUIN <br />95204 <br />MAILING ADDRESS <br />CITY <br />STATE <br />IIP <br />2937 VENEMAN ROAD <br />MODESTO <br />CA <br />95356 <br />PHONE W/APEA CODE <br />TYPE OF BUSINESS <br />�9" z <br />(X) 01 GASOLINE STATION f ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />JAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />fOM EFAW 209-578-9716 TOM EFAW 209-527-0870 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER: <br />NUMBER 14t37-3 <br />B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG C. YEAR INSTALLED 1972 ( ) UNKNOWN <br />D. CONTAINER CAPACITY: 10000 GALLONS ( l 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 BOX(ES): <br />( ) 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br />' V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: <br />( 1 GAUGE <br />( ) INCHES ( <br />) CM (X) UNKNOWN <br />B. <br />f ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 <br />NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLEO ( <br />7 03 LINED <br />0. <br />(X) 01 <br />( ) <br />( J 12 <br />CARBON STEEL ( ) 02 STAINLESS STEEL <br />06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 <br />UNKNOWN ( ) 13 OTHER: <br />( ) 03 FIBERGLASS ( ) 04 <br />BRONZE f ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( 7 05 CONCRETE <br />( ) 10 NON-METALLIC <br />I HSC04-070185 (10/18/85) PAGE 1 <br />