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STATE IO NUMBER 00000010313001 <br /> APPLICATION FOR PERMIT TO OPE EI UNDERGROUND STORAGE TANK <br /> QV 01 NEW PERMIT [ 1 05 RENEWED PERMIT ( NK CLOSED ( ) 09 DELETE FROM FILE (NO FEEL <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> PACIFIC READY MIX INC ( ) 01 FED l ) 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS CITY ST.4iE ZIP <br /> 850 SAN MATEO INC SAN MATED CA 94401 <br /> II FACILITY <br /> FACILITY NAME1Cc <br /> V m_ ' DEALER/FOREMAN/SUPERVISOR <br /> 7r Art^ <br /> STREET ADDRESS \ . NEAREST CROS STREET —_ <br /> 651 So. .WAGAOTMeRi- f�=\A. A' �W_�l F l,yu l Z-._ <br /> CITY COUNTY ZIP <br /> TRACY SAN JOAQUIN 95376 <br /> M.AILZNG ADDRESS �i CITY STATE ZIP <br /> 651 50. ER Mac 4-/t-71AA ]SAM I <br /> AME CA 95376 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-835-0770 ( ) 01 GASOLINE STATION (X) 02 OTHER READY MIX CONCRETE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2 <br /> III 2A 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 /> � t C7MPLETE T F 0 L L-c-)w7N-r ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED fX) UNKNOWN <br /> D. CONTAINER CAPACITY: _—Z!!!F GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ] 01 WASTE fX) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) O1 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOXIEST: <br /> E ) 01 UNLEADED ( 1 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 7 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( 1 INCHES f 1 CM (X) UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED 02 SINGLE WALLED ( ) 03 LINED <br /> 0. O1 CARBON STEEL ( l 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 105 CONCRETE <br /> ) 06 ALUMINUM ( 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( 110 NON-METALLIC <br /> ) 13 OTHER: <br /> HSC04-070165 (10/18!85) <br /> PAGE 1 <br /> (EA <br /> DATE OF LAST I PE TION- -COMPLIxnce -- rcm.., ,..-r.... <br /> 6 - � - ---- -- -- <br />`h � ) OS YES ( ) 02 NO I �_.__. _�_ ___ .. <br /> HSC04-070185 (10/18/85) PAGE 2 <br />