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.R/ STATE ID NUMBER 00000064217003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STOR GE TANK <br /> ( ) 01 NEW PERMIT 1 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( 09 DELETE FROM FILE (NO FEE) <br /> f 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM!(CORPORATION.INDIVIOUAL OR PUe IC AGENCY) PUBLIC AGENCY ONLY <br /> Ff , �, 0 ( ) 01 FED f ) 02 STATE ( 1 03 LOCAL <br /> STRCFT ADDRESS I � � I CITY STATE ZIP <br /> IL MANTECA CA 95336 <br /> II FACILITY <br /> FACILITY NAME OEALFR/FOREMAN/SUPERVIS<7R� <br /> TEXACO -a.... <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 ZIP <br /> 941 E. YOSEMITE AVE. MANTECA CA 95336 <br /> TAPE OF BUSINESS <br /> X) 01 GASOLINE STATION f 1 02 OTHER <br /> NUMBER OF CONTAINERS 1 RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <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 COD! <br /> DOMRIV-M--KRRNBEI� L04=S'�2�D� AR - - <br /> COMP4 TE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. 1X1 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( l UNKNOWN E. DOES THE CONTAINER STORE: l ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOXIEST: <br /> f ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL 1 105 WASTE OIL l ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (XI UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED f ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f 103 LINED <br /> D., 1 ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL l ) 03 FIBERGLASS l 1 04 POLYVINYL CHLORIDE ( I OS CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD ( ) 08 BRONZE 1 1 09 COMPOSITE ( 110 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> ISC04-070185 (10/18/85) ( PAGE 1 <br />