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• • STATE ID NUMBER 00000018854002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> f ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> TIME OIL CO. ( ) 01 FED l ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 2737 W. COMMODORE WAY SEATTLE WA 98199 <br /> II FACILITY <br /> FACILITY NAME DEALEP/FOR1MAN/SUPffRVpSOP rr <br /> TIME OIL CO HENRY J. BAILEY A L <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3015 NAVY DR. WASHINGTON ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 3015 NAVY DR. SAME WA 95206 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-462-3848 ( ) 01 GASOLINE STATION tX) 02 OTHER PETROLEUM TERMINAL <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 /> BAILEY, HENRY J. 415-232-7447 SAME - - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 121 <br /> B. MANUFACTURER (IF APPROPRIATE): BUTLER MFG. YEAR MFG: C. YEAR INSTALLED 1974 [ 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS l ) UNKNOWN E. DOES THE CONTAINER STORE: ( J 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 /> t I <br /> 01 UNLEADED l ) 02 REGULAR f 1 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL (X) 06 OTHER BLEND GASOLINE <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( ) CM ( 1 UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) tX) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL f l 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ! ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE f 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 0 • <br />