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.i <br /> STATE ID NUMBER 00000064653003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> O l S1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> (T) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CAL TRANS f 1 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STPIET ADDRESS CITYSTATE ZIP <br /> 1976 E. CHARTER WAY STOCKTON CA 95205 <br /> II FACILITY <br /> FACILITY NAME DEALER/FCREMAtVSUPlRvlSO <br /> TRACY MS J65GE-RA'I4MJ'* J�j(( �(I <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 24155 S. CORRAL HOLLOW RD. <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 95376 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 24155 S. CORRAL HOLLOW RD. TRACY CA 95376 <br /> PHONE W/AREA CODE TYPE OFBUSINESS <br /> 209-835-6779 ( l 01 GASOLINE STATION (X) 02 OTHER MAINTENANCE STATION <br /> NUMBER0 CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> WELLS. A.D. 209-948-7300 G. HOUSTON 209-874-3241 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER 305-5 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS &*9 UNKNOWN E. DOES THE CONTAINER STORE: l ) 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 /> ( ) <br /> 01 UNLEADED f 1 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL NH-06 OTHER -UN+N)WH - <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE [ l INCHES ( 1 CM (X1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 02 NON-VAULTED W7 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE l 1 09 COMPOSITE f ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 1� � <br />