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wW �,/ STATE ID NUMBER 00000064217002 <br /> APPLICATION FOR PERMIT TO OP ATE UNDERGROUND STORAGE TANK <br /> f 1 01 NEW PERMIT f 1 05 RENEWED PERMIT ( 07 TANK CLOSED ( 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT 1 1 06 AMENDED PERMIT 1 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM 11 CC P P O PATION�INpIVIDUAL OR PUDLIC AGENCY) PUBLIC AGENCY ONLY <br /> H�R9iDEN �� L_.Y r ( ) 01 FED 1 1 02 STATE ( I 03 LOCAL <br /> STREET ADDRESS TY STATE IIP <br /> 5 s f MANTECA CA 95336 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPEPV OR <br /> U&2*W-S TEXACO Do 0 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 941 E. YOSEMITE AVE. POWERS AVE. <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> MAILING ADDRESS CITY STATE IIP <br /> 941 E. YOSEMITE AVE. MANTECA CA 95336 <br /> iMONF W/A PlA CO ! TYPE OF DUSINESS <br /> ` (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NJMDER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/ARCA COD! NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE <br /> 201-Qii-E866-' - - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 1000 GALLONS l ) UNKNOWN E. DOES THE CONTAINER STORE: ( 1 Ol WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( 1 01 YES 1 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED ( 1 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL l 1 05 WASTE OIL f l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1 ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> S. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 102 SINGLE WALLED f 1 03 LINED <br /> 0. ( ) 01 CARBON STEEL f ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS l l 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( l 09 COMPOSITE ( 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />