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�r -ftRf STATE ID ER 00000064217004 <br /> APPLICATION FOR PERMIT TO OP RATE UNDERGROUND STORA TANK <br /> ( 1 01 NEW PERMIT l ) 05 RENEWED PERMIT ) 07 TANK CLOSED f 09 DELETE FROM FILE (NO FEE) <br /> 1 1 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE <br /> I OWNER <br /> NAY.fICOR PORATIDUON.I ND I V I AL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> - �� M <br /> 01 FED f 1 02 STATE t 1 03 LOCAL <br /> STREET ADDRESS '�11 1�/ CITY STATE ZIP <br /> MANTECA CA 95336 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPER OR <br /> KOUER"S'(EXACO G_Ltil. SL/b� <br /> STP99T 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 /> PXO HF W/ARlA <br /> ODE , <br /> TYPE Of :U <br /> TYPE <br /> >^s mea-cfef _ c, $ l 1X1 O1 GASOLINE STATION t 1 02 OTHER <br /> NUMBER 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/AREA COD! NIGHTS: NAM[ILAST NAME FIRST) AND PHONE W/AREA CODE <br /> vORXEv_N-r1RH9ld_ l20T-MMEB6" - - <br /> d� <br /> CO PLETE THE F LLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK l 1 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER fIF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( 1 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 /> ( ) 01 UNLEADED f ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL l ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( 1 INCHES ( 1 CM (XI UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN (UNDERGROUND VAULT) 1X1 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED l ) 03 LINED <br /> D. ( ) 01 CARBON STEEL l ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE l 1 10 NON-METALLIC <br /> (X) 12 UNKNOWN 1 ) 13 OTHER: <br /> NSC04-070185 (10/18/851 PAGE 1 <br /> /_. Now <br />