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STATE ID NUMBER 00000051824001 <br /> APPLICATION FOR PERMIT TO OPERATE UND GROUND STORAGE TANK <br /> ( I <br /> 01 NEW PERMIT ( l 05 RENEWED PERMIT ) <br /> TANK CLOSED (JC' 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> EDWARD E. WILSON ( 1 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE IP <br /> 11714 W. FINCH RD. TRACY CA 95376 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> HEINWKEL'S GROCERY EDWARD E. WILSON <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 11700 W. FINCH RD. TRACY BLVD. <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> 11700 W. FINCH RD. TRACY CA 95376 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-835-4619 ( 1 O1 GASOLINE STATION (X) 02 OTHER GROCERY <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <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 /> SANSING, JUNIOR 209-835-2943 SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 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 f ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL (X) 06 OTHER EMPTY <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( 1 INCHES ( 1 CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f 1 03 LINED <br /> D. f ) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS 1 ) 04 POLYVINYL CHLORIDE l 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD [ ) 08 BRONZE ( 1 09 COMPOSITE 1 ) 10 NON-METALLIC <br /> IX) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/16/85) PAGE 1 <br /> low \"/ <br />