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1. 0STATE ID NUMBER 00000058143001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (XI O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT t ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,ZNDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> MANTECA LATHROP RURAL RSRE-4**c4gU ,� D ` l 1 01 FED ( ) 02 STATE ( 7 03 LOCAL <br /> CITY STATE ZIP <br /> STREET ADDRESS <br /> 800 E. J ORE LATHROP CA 95330 <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME y� n/u� lv+nTt�� (� JIM ENNES <br /> MANTECA LATHROP RURAL^FlRtMFCQ[Lg ( fpjj- (w C.� <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 800 E. J ST. CAMBRIDGE <br /> CITY COUNTY ZIP <br /> LATHROP SAN JOAQUIN 95330 <br /> MAILING ADDRESS CITY STATE IIP <br /> P.O. BOX 151 MANTECA CA 95336 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-982-5170 ( ) 01 GASOLINE STATION (X) 02 OTHER FIRE DIST. <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/AREA CODE <br /> ENNES JAMES 209-858-2331 ENNES. JAMES z09-eez=s7Tagyy,�- <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> TV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER ARl <br /> E. MANUFACTURER (IF APPROPRIATEI: YEAR MFG: 1983 C. YEAR INSTALLED 1983 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN I 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 /> l 1 01 UNLEADED (X) 02 REGULAR t ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM f 1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. 1 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( I 01 CARBON STEEL ( ) 02 STAINLESS STEEL (X) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM 1 l 07 STEEL CLAD ( 1 08 BRONZE t ) 09 COMPOSITE f ] 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE I <br />