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0 0 STATE ID NUMEER 00000031604003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />( ) 01 NEW PERMIT ( } 05 RENEWED PERMIT <br />( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT <br />I OWNER <br />( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />E ) 08 MINOR CHANGE ENO SURCHARGE) <br />NAil!(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />CITY OF MANTECA ( ) 01 FED ( ) 02 STATE i ) 03 LOCAL <br />STPE€T ADDPESS CITY STATE ZIP <br />1001 WEST CENTER ST. MANTECA CA 95336 <br />II FACILITY <br />FACILITY NAME <br />10000 GALLONS t <br />) UNKNOWN <br />DEALER/FOREM.AN/SUPERVISOR <br />CONTAINER STORE: ( <br />CITY OF MANTECA <br />F. DOES THE CONTAINER <br />STORE MOTOR VEHICLE <br />RAY ZUNINO <br />01 YES ( ) 02 NO <br />STREET ADDRESS <br />( ) 01 UNLEADED ( <br />) 02 REGULAR ( ) 03 <br />NEAREST CPCSS' STREET <br />( ) 05 WASTE OIL <br />( ) 06 OTHER <br />210 EAST WETMORE AVE. <br />S0. MAIN/ST. <br />CITY <br />COUNTY <br />ZIP <br />MANTECA <br />SAN JOAQUIN <br />95336 <br />MAILING ADDRESS <br />r� .3 <br />CITY <br />STATE <br />ZIP <br />jfr C/s (� <br />MANTECA <br />CA <br />95336 <br />PHONE 'A/APER COLE <br />TYPEOF <br />BUSINESS <br />209-239-45 4-1 Y AfS—o <br />( ) <br />01 GASOLINE STATION (X) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS <br />ONLY <br />TOWNSHIP <br />RANGESECTICN <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: N.AME(LAST NAME FIRST) AND PHONE W/AREA CODE <br />Jit#tcEAESr DAVID 209-239-953:1 J'INKENS, DAVID 209-239-9511 <br />COMPLETE T€4E FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER: <br />B. MANUFACTURER (IF APPROPRIATE): MODESTO WELDING <br />CONTAINER NUMBER CY-,c 1 <br />YEAR MFG: 19761 C. YEAR INSTALLED 1976 I ) UNKNOWN <br />D. CONTAINER CAPACITY: <br />10000 GALLONS t <br />) UNKNOWN <br />E. DOES THE <br />CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. DOES THE CONTAINER <br />STORE MOTOR VEHICLE <br />FUEL OR WASTE OIL ? (X} <br />01 YES ( ) 02 NO <br />IF YES CHECK APPROPRIATE BOXIES): <br />( ) 01 UNLEADED ( <br />) 02 REGULAR ( ) 03 <br />PREMIUM (X) 04 DIESEL <br />( ) 05 WASTE OIL <br />( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE ( 1 INCHES ( l CM i ) UNKNOWN <br />B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED i ) 03 UNKNOWN <br />C. ( } 01 DOUBLE WALLED (X) 02 SINGLE WALLED t ) 03 LINED <br />D. (X) 01 CARBON STEEL t 1 02 STAINLESS STEEL f 1 03 FIBERGLASS [ } 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 06 ALUMINUM ( } 07 STEEL CLAD ( } 08 BRONZE f } 09 COMPOSITE ( } 10 NON-METALLIC <br />( l 12 UNKNOWN ( ) 13 OTHER. <br />6 KSC04-070185 (10/18/85) <br />0 <br />Ll <br />PAGE 1 <br />