Laserfiche WebLink
STATE ID NUMBER 00000023953001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> OG1 O1 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> CONDITIONAL PERMIT l 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N&ME(CORPCRATION,XNDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> EXXON COMPANY U.S.A. ( 1 01 FED ( ) 02 STATE f l 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 16945 NORTH CHASE BLVD. HOUSTON TX 77210 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> EXXON SERVICE STATION RANDY VETESY <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3128 W. BENJAMIN HOLT <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95207 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 3128 W. BENJAMIN HOLT STOCKTON TX 95207 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-478-6401 (X) O1 GASOLINE STATION ( 102 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 4 <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 /> HOFFMAN, S.D. 415-937-2991 HOFFMAN, S.D. 415-372-3361 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: 1971 C. YEAR INSTALLED 1971 f ) UNKNOWN <br /> D. CONTAINER CAPACITY: 6000 GALLONS 1 1 UNKNOWN E. GOES 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 ( 1 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> S. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 103 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL f l 03 FIBERGLASS l 1 04 POLYVINYL CHLORIDE f 105 CONCRETE <br /> f ) 06 ALUMINUM f ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE f ) 10 NDN-METALLIC <br /> ( ) 12 UNKNOWN f ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE ;i <br /> t <br /> Amo/ �. <br />