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• • STATE ID NUMBER 00000028920003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE <br /> DELETE FROM FILE (NO FEE) <br /> ( ) O1 NEW PERMIT ( ) -05 RENEWED PERMIT ( 1 07 TANK CLOSED <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHAR <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> WGARYS. <br /> RA7!ON,:NOIVIDUAL OR PUBLIC AGENCY) ( ) O1 FED I ) 02 STATE ( ) 03 LOCAL <br /> LBRETH. STATE ZIP <br /> CITY CA 95336 <br /> RESS MANTECA <br /> MITE <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME <br /> RAINWATER CAR WASH <br /> NEAREST CROSS STREET <br /> STREET ADOPESS JESSIE <br /> 420 W. YOSEMITE IIp <br /> COUNTY 95336 <br /> CITY SAN JOAQUIN <br /> MANTECA STATe Z95IP <br /> CITY CA 336 <br /> MAILING ADDRESS MANTECA <br /> 420 W. YOSEMITE <br /> TYPE OF BUSINESS <br /> PHONE W/AREA CODE (X) 01 GASOLINE STATION ( 1 02 OTHER <br /> 209-823-7003 RANGE SECTION <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY : TOWNSHIP <br /> 3 <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 /> GARY CULBRETH <br /> 209-951-1347 SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> CONTAINER NUMBER 3 <br /> A. (X) 01 TANK ( ) 04 OTHER: <br /> YEAR MFG: C. YEAR INSTALLED <br /> ( ) UNKNOWN <br /> B. MANUFACTURER (IF APPROPRIATE): <br /> D. CONTAINER CAPACITY: GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( l O1 WASTE ( ) 02 PRODUCT <br /> F. DOES0THE CONTAINER STORE <br /> ERMOTOR VEHICLE03FUEL ORMWASTE 04LDIESEL O( 1E 2OISCHECK APPROPRIATE BOX(ES): <br /> 05 WASTE OIL ( ) 0607HER <br /> LEADED <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( ) INCHES ( ) CM ( 1 UNKNOWN <br /> B, ( ) O1 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) O1 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> LORIDE <br /> S 0 <br /> D ( )(Ol CARBON06 STEEL (( 110725TEE LNCLAD STEEL 08(BRONZE03 F IBERG095COMPOSITE POL)V10YNONHMETALLIC( ) 05 CONCRETE <br /> INUM <br /> ( 9 12 UNKNOWN ( ) 13 OTHER: PAGE 1 <br /> HSC04-070185 (10/18/85) <br /> +M M <br />