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0 0 STATE ID NUMBER 00000031604002 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />(,[<O1 NEW PERMIT ( ) 05 RENEWED PERMIT f 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (HO FEE! <br />f ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ► 08 MINOR CHANGE (NO SURCHARGE) <br />T OWNER <br />NAME(COPPORATION.INDIVIDU.4L OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />CITY OF MANTECA I ( ) 01 FED ( ) 02 STATE L. -\r'03 LOCAL <br />STREET ADDRESS CITY STATE ZIP <br />1001 WEST CENTER ST. MANTECA ICA 95336 <br />TT rArTi TTV <br />FACILITY NAME <br />NAME FIRST) AND PHONE W/APEA CODE <br />DEALER/FDREMAN/SUPERVISOR <br />CITY OF MANTECA <br />NAME(LAST NAME <br />MY ZUNINO <br />STREET ADDRESS <br />209-2393. glf Q <br />NEAREST C OSS STREET <br />210 EAST WETMORE AVE. <br />DAVID <br />50. MAIV ST. <br />CITY <br />) 03 LINED <br />COUNTY <br />ZIP <br />MANTECA <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />SAN JOAQUIN <br />95336 <br />MAILING ADDPESS <br />CITY <br />STATE <br />CA <br />ZIP <br />95336 <br />P,0. io <br />MANTECA <br />PHONE W/.AREA CODE <br />TYPE OF BUSINESS <br />209_239-94.1], ';rf jC> <br />( ) 01 GASOLINE STATION (X1 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS CNLY <br />TOWNSHIP <br />RANGE SECTION <br />3 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />0.YS: NAME(LAST <br />NAME FIRST) AND PHONE W/APEA CODE <br />CONTAINMENT: 1/4 <br />NIGHTS: <br />NAME(LAST NAME <br />FIRST) AND PHONE W/AREA CODE <br />r DAVID <br />209-2393. glf Q <br />1 03 UNKNOWN <br />JINKENSr <br />DAVID <br />209-239-9511 <br />(X) 02 SINGLE WALLED f <br />) 03 LINED <br />D. <br />(X) 01 <br />f ) <br />f ) 12 <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER: <br />B. MANUFACTURER (IF APPROPRIATE): UNKNOWN <br />CONTAINER NUMBER CY-3 <br />YEAR MFG: 19781 C. YEAR INSTALLED 1978 ( ) UNKNOWN <br />D. CONTAINER CAPACITY: 10000 GALLONS f ) UNKNOWN E. ROES THE CONTAINER STORE: [ ) 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 />{X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br />v r_nNTATNFR CC)NSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 1/4 <br />f 1 GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />1 03 UNKNOWN <br />C. <br />{ 1 01 <br />DOUBLE WALLED <br />(X) 02 SINGLE WALLED f <br />) 03 LINED <br />D. <br />(X) 01 <br />f ) <br />f ) 12 <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />( ) 02 STAINLESS STEEL ( <br />( ) 07 STEEL CLAD ( 1 08 <br />13 OTHER: <br />) 03 FIBERGLASS C ) 04 <br />BRONZE ( 1 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />f ) 10 NON-METALLIC <br />S HSC04-070185 (10/18/85) <br />C <br />Ll <br />PAGE 1 <br />