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• STATE ID NUMBER 00000062513001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> O1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 1 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( 7 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIIDUAL I OR PUBLIC AGENCY) �(J t 'PUBLIC AGENCY ONLY <br /> GHEVRPH•-US IMC' G10.U4e Ef��ie- M J re-.S)'1eRr ( ) Ol FED f ) 82 STATE ( ) 03 LOCAL <br /> STREET ADDRESS -- _ - CITY STATE ZIP S`qL <br /> 39S'MARRET a s*H_fRANCF568 F'VIQ,4CA <br /> II FACILITY <br /> FACILITY NA //t� '� DEALER/FOREMAN/SUPERVISOR <br /> 93823- r'e-�.E.ea.r5 Cyte. r\-U r8 � 3[�a-3 BRESHEARS,C M <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 824 E. YOSEMITE AVE. POWERS <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 824 E. YOSEMITE AVE. MANTECA CA 95336 <br /> PHONE .W/AREA CODE TYPE OF BUSINESS <br /> 209-823-5717 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> GAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> M'INTENUICE DZSPPA17HkXj <br /> �T� TT D'l44 <br /> r ke--4.Lrs L(a u. '�-0 -571 Z <br /> FOLL ING ON A SEPARATE FORM FOR EACH <br /> IV DESCRIPTION <br /> A. (X) 01 TANK. ( ) 04. OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1965 C. YEAR INSTALLED 1%5 E ) UNKNOWN <br /> D. CONTAINER CAPACITY: /a GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINS TOR MOTOR VEHICLE FUEL OR WASTE OIL ? .( ) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) <br /> 01 UNLEADED REGULAR ( 1 .03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OI.L ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 0000250 ( ) GAUGE f ) INCHES ( ) CM 4 1 UNKNOWN <br /> • B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE f 1 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> MSC04-070185 (10/18/85) PAGE 1 <br />