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• STATE ID NUMBER 00000012408003 <br /> APPLICATION FOR PERMIT T-© OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED [ 1 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( J 06 AMENDED PERMIT ( ) 03 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPGPATICN.INDIVIDUAL CR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> THE SOUTHLAND CORPORATION ( ) 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> __[ <br /> STREET ADDRESS CITY S <br /> TATE <br /> 5820 STONERIDGE MALL ROAD, 1631 RLEASANTON <br /> II FACILITY <br /> FACILITY N4,ME DEALER/FOREMAN/SUPERVISOR <br /> 7-ELEVEN FOOD STORE 2243-21756 R05E KNAPP <br /> STREET ADDPESS NEAREST CROSS STREET <br /> 853 E. YOSEMITE _ POWER STREET <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> ',. ILING A00;ESS CITY STATE ZIP <br /> 2937 VENEMAN ROAD MOOESTO CA 95356 <br /> PHCNE W."A EA CODE TYPE OF SUSTNESS <br /> 209_ ga �to (X) 01 GASOLINE STATION ( l 02 OTHER <br /> N'JY.3ER GF CONTAINERS RURAL AREAS ONLY TOWNSHIP PANGE SECTION <br /> 3 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NiME(LAST NAME fIPST) AND PHONE W/AREA CODE NIGHTS: NAME(LASl NAME FIRST) AND PHONE WiAREA 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. tX) 01 TANK ( l 04 OTHER. CONTAINER NUMBED-- M-,a -? <br /> B. MANUFACTURER (IF APPROPRIATE); UNKNOWN YEAR MFG: C. YEAR INSTALLED 1980 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY . 10000 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 /> ( 1 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED [ 1 03 UNKNOWN <br /> C. ( 101 DOUBLE WALLED [X) 02 SINGLE WALLED [ l 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> 4 ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE i ) 09 COMPOSITE [ 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( 113 OTHER: <br /> H3C04-070185 (10/18/85) PAGE 1 <br />