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STATE ID NUMBER <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> NEW PERMIT - l 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED f ) 09 DELETE FROM FILE 040 FEE) l <br /> CONDITIONAL PERMIT _1 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) - - - �---1 <br /> 1 OWNER <br /> "AME'CO00CPR7ION.INOIYIDUA OR PUBLIC AGENCY PUBLIC AGENCY ONLY <br /> i r <br /> 01 FED f 1 02 STATE I I 03 LOCAL <br /> f'STGEET AC^.KESS - CIT STATE ZI <br /> II FACILITY <br /> FGIL1TT NAME — OEALERlFOPE EN�SUPEPY SOP <br /> fA— <br /> STAE1FfT^�ACC27ESS P NEAPES CROS STPEET <br /> C 1 TY . R •.. - - <br /> COUNTY 1z, 3 b <br /> MAIL) ADJES - <br /> --- ` � FC, <br /> Y STA_ TE ZIP 3 <br /> PH04!'ACE.... E�GI� IT <br /> YPE OF BUSINESS <br /> 01 GASOLINE STATION t 1 02 OTHER `V <br /> -_oma-�.�• <br /> r�tUt"BER,CF CONTAI`lEzS -- `----� PUPA) ApEAS ONLY TnWNSkIPRANGE ON <br /> SECTION <br /> III 26 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NA+~,EILAST lIAME FIPST) AND PHONE W/AR A CODE NIGHTS: NAME( LAST NAME FIRST) AND PHONE WlPEA CODE <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ( 01 TA11K ( 1 02 OTHER CONTAINER NUMBER 1 <br /> I <br /> B. MANUFACTURER (IF APPROPRIATE)' YEAR MFG: C. YEAR INSTALLED I 1 UNKNOWN <br /> 0. CONTAINER CAPACITY:- ���G.ALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: 1,�1 01 WASTE [ 102 PRODUCT — <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? O`? 01 YES 1 1 02 NO IF YES CHECK APPROPRIATE BOX(ESI: <br /> —( 1 <br /> 01 UNLEADED i 1 02 REGULAR 1 1 03 PREMIUM I ) 04 DIESEL l05 WASTE OIL t 106 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ! GAUGE f J INCHES f 1 CM f 9 UNKNOWN — <br /> IIB. t 1 01 VAULTEII (LOCATED IN AN UNDERGROUND VAULT) ), 02 NON-VAULTED ( 1 03 UNKNOWN <br /> JC. ( 101 DOUBLE WALLED 1 0 SINGLE WALLED t 1 03 LINED - ------ <br /> D. (*, , <br /> -OI-CARBON STEEL `( 1 02 STAINLESS STEEL f 1 03 FIEERGLASS ( ) 04 POLYVINYL CHLORIDE 1 J 05 CONCRETE <br /> / 1 1 06 ALUMINUM ( 1 07 STEEL CLAD I 1 08 BR01fZE 1 J 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 U1IKNOWN ( 1 13 OTHER: <br /> HSC04-070185 PAGE 1 <br />