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STATE ID NUMBER 00000008153001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />LI:T'01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />""n2 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />VAME(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />TIME OIL CO. ( ) 01 FED ( ) 02 STATE f ) 03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />?737 W. COMMODORE WAY SEATTLE WA 91 <br />II FACILITY <br />FACILITY NAME <br />(XI Ol TANK ( ) 04 OTHER: <br />DEALER/FOREMAN/SUPERVISOR <br />) CM ( ) UNKNOWN <br />ft0RTCRr3_GXS-M*R-T--Q <br />003 <br />VINCENT F. BLANK <br />MANUFACTURER (IF APPROPRIATE): MODERN <br />STPEET ADORESS <br />YEAR MFG: 1976 <br />NEAREST CROSS STREET <br />YEAR INSTALLED 1976 ( ) UNKNOWN <br />13475 JACKTONE RD. <br />CONTAINER CAPACITY: 6000 GALLDNS ( <br />L <br />E. DOES THE CONTAINER STORE: ( <br />CSTY <br />(X) 02 PRODUCT <br />COUNTY <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />f 1 01 UNLEADED ( 1 02 REGULAR03 <br />ZIP <br />• LO <br />APPROPRIATE SOX(ES): <br />SAN JOAQUIN <br />95240 <br />MAILING ADDRESSCITY <br />STATE <br />ZIP <br />13475 JACKTONE RD. <br />( <br />95240 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-368-4381 <br />(X) 01 GASOLINE STATION ( ) 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 />DAYS: NAME(l4ST NAME FIRST) AND PHONE W/AREA CODE NIGXTS: NAM!(IAST NAME FIRST) AND PHONE W/AREA CODE <br />iIGNIGHT, STEVEN C. 916-423-1998 SAME - - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(XI Ol TANK ( ) 04 OTHER: <br />( ) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />CONTAINER NUMBE 4)9 <br />003 <br />B. <br />MANUFACTURER (IF APPROPRIATE): MODERN <br />WELDING <br />YEAR MFG: 1976 <br />C. <br />YEAR INSTALLED 1976 ( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 6000 GALLDNS ( <br />) UNKNOWN <br />E. DOES THE CONTAINER STORE: ( <br />) 01 WASTE <br />(X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE <br />f 1 01 UNLEADED ( 1 02 REGULAR03 <br />FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />ffFplUM ( 1 04 DIESEL ( 1 05 WASTE OIL <br />IF YES CHECK <br />Wr06 OTHER <br />APPROPRIATE SOX(ES): <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: 1/4 <br />( ) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />f ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (XI 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( <br />103 LINED <br />D. <br />fX) 01 <br />( ) <br />f ) 12 <br />CARBON STEEL ( ) 02 STAINLESS STEEL <br />06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 <br />UNKNOWN ( ) 13 OTHER: <br />f 1 03 FIBERGLASS ( 1 04 <br />BRONZE f l 09 COMPOSITE <br />POLYVINYL CHLORIDE ( l 05 CONCRETE <br />( 1 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />,�V/ 1� <br />PAGE 1 <br />