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*.e-"J ej �o STATE ID NUMBER 00000024099002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 1 01 NEW PERMIT ( ) 05 RENEWED PERMIT (V07 TANK CLOSED 00 09 DELETE FROM FILE (NO FEE) <br /> f ) 02 CONDITIONAL P€RMIT ( ) 06 AMENDED PERMIT f ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> EXXON COMPANY U.S.A. ( 1 01 FED ( ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 16945 NORTHCHASE BLVD HOUSTON TX 77210 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> EXXON SERVICE STATION MOHAMMAD A. TOEB <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4444 N. PERSHING <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95207 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 4444 N. PERSHING STOCKTON TX 95207 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-473-9551 (X) 01 GASOLINE STATION ( ) 02 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 NIONTS: NA ME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> HOFFMAN. 5.0. 415.oii-E99t5 HOFFMAN� 5.0. 415-372-3361 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 7 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: 1966 C. YEAR INSTALLED 1966 ( 1 UNKNOWN <br /> D. CONTAINER CAPACIT • 8000 GALLONS ( I UNKNOWN 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 f ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 1 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL f 7 02 STAINLESS STEEL f ] 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 7 07 STEEL CLAD ( 7 08 BRONZE [ ] 09 COMPOSITE ( ] 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> �t low <br />