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0 STATE ID NUMBER 00000012408002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (401 NEW PERMIT C 1 05 RENEWED PERMIT ( } 07 TANK CLOSED t ) 09 DELETE FROM FILE ((i0 FEE) <br /> ( } 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT f 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CCPPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> THE SOUTHLAND CORPORATION i 1 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STPEET 4DDPESS CITY FCA <br /> TE 2IP <br /> 5820 STONERIDGE MALL ROAD, #31 PLEASANTON 94566 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> 7—ELEVEN FOOD STORE 2243-21756 ROSE KNAPP <br /> STREET ADDRESS NEAPEST CPOSS STREET <br /> 853 E. YOSEMITE POWER STREET <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILIN3 .ADDRESS CITY STATE ZIP <br /> 2937 VENEMAN ROAD MODESTO ICA 95356 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209 (XI 01 GASOLINE STATION ( 1 02 OTHER <br /> NUMBER CF CONTAINERS RURAL 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 NAME FIRST) AND PHONE W/AREA CODE <br /> TOM EFAW 209-578-9716 TOM EFAW 209-527-0870 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK C ) 04 OTHER: CONTAINER NUMBER 2356-7 <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1980 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) UNKNOWN E. DOES 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 ( ) 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: C ) GAUGE C 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON—VAULTED ( ) 03 UNKNOWN <br /> C. C } 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. {X) 01 CARBON STEEL i ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ] 05 CONCRETE <br /> ( ) 06 ALUMINUM d 1 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE { 1 10 NON—METALLIC <br /> ( ) 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) u —PAGE 1 <br />