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0 0 STATE ID NUMBER 00000028920002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( O1 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT (. ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,IN IVIDUA1L OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> �F ` ( # �1 YL L. ',� f 1 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 420 W YOSEMITE MANTECA CA 95336 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> RAINWATER CAR WASH L. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 420 W. YOSEMITE JESSIE <br /> CITY COUNTY <br /> IIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS CITY STATE Zip <br /> 420 W. YOSEMITE MANTECA CA 95336 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-823-7003 (X) 01 GASOLINE STATION l ) 02 OTHER <br /> NUMBER OF CONTAINERS P.URAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST <br /> NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> GRR*-EHtBR T44 - 47 C.SAME <br /> _. <br /> COMPLE E THE SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED f ) UNKNOWN <br /> D. CONTAINER. CAPACITY: LLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE f 1 02 PRODUCT <br /> F. OES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> O1 UNLEADED ( 1 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM ( ) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (�J_92 NON-VAULTED f ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (�14 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ] 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br />