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` STATE ID NUMBER 00000031086001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) O1 NEW PEF.MIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (tJ0 FEE1 <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(C07PCRATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ROBERT L. EVANS ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET .ADDRESS CITY STATE ZIP <br /> 21010 S. MANTECA RD. MANTECA CA 95336 <br /> II FACILITY <br /> FACILITI NA Mc DEALER/FOREMAN/SUPERVISOR <br /> BCB EVANS ROBERT L. EVANS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 21010 S. MANTECA RD. WOODWARD AVE. <br /> CITY COUNTY ZIP <br /> MANTECA SAN JOAQUIN 95336 <br /> M=:LING ADDF.ESS CITY STATE ZIP <br /> 21010 S. MANTECA RD. MANTECA CA 95336 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-239-3407 ( 1 01 GASOLINE STATION (X) 02 OTHER FARM <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: N.AME(LAST NAME FIRST) AND PHONE W/AP.EA CODE NIGHTS: N.AME(LAST NAME FIRST) .AND PHONE W%AREA CODE <br /> EVANS, ROBERT 209-239-3407 EVANS, ROBERT 209-239-3407 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( l 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: 10000 GALLONS ( ) 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 ( l 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 1/2 ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( l 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( l 03 LINED <br /> D. ( ) 01 CAPEON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD ( l 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( l 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> s <br />