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''' <br /> STA pe D N <br /> v UMBER 00000001439002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> M i Wrw PPRMTT ( ) 05 RENEWED PERMITl ) 07 TAW( CLOSED <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE)) 09 DELETE FROM FILE (NO FEE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) <br /> MODESTO TALLOW COMPANY PUBLIC AGENCY ONLY <br /> ( ) <br /> 01 FED ( 1 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS <br /> 925 CROWS LANDING ROAD CITY STATE zxp <br /> MODESTO CA 95353 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SVP�.RVJI OR <br /> FOSTER FOODS DISTRIBUTION CENT Ki)R?riiBMtEMBERp iyIQN fu�fr!/%Sal^ <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 4221 E. MARIPOSA ROAD <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95205 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 4221 E. MARIPOSA ROAD STOCKTON CA 95205 <br /> PHONE W/AREA CODE TYPE OF BUSINESS '/- <br /> 209-943-0155 (.�1 01 GASOLINE STATION fx) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 2 <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/APEA CODE <br /> NBHLEAIBERG---IG1)RI- E@4 943-BtS5- W2,w.& Ep6r-RIiRT 209_143_D13*J <br /> -01 z61 <br /> COMPLETE THE FOLLOWING ON A SEPARA FORM FOR EACH CONTAINER �5 <br /> IV DESCRIPTION <br /> A. (X) 01 TAW ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> /y73 <br /> S. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED (jr) UNKNOWN <br /> 0. CONTAINER CAPACITY: 300ff GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: { ) 01 WASTE (XI 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 /> t 1 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL [ l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (XI 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (}G 02 SINGLE WALLED [ 1 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ] 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> `0 <br />