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STATE ID NUMBER 00000001123001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED f 1 09 DELETE FROM FILE (NO FEE) <br /> t 4 02 CONDITIONAL PERMIT C l 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAM.E(CCP.PORATION.INCIVIOU.AL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> FED ( ) 02 STATE t 1 03 LOCAL <br /> STRE!i ARDPESS CITY / STATE ZIP <br /> - " AJ f� CA f �. <br /> II FACILITY <br /> F.4CIL'TY N=MEjt'.I-- DEALER/FOREMAN/SUPERVISOR <br /> r r`J hd ( S 7 J( L4 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 815 MOFFATT BLVD. POWERS <br /> CITY COUNTY ZIF <br /> MANTECA SAN JOAGUIN 95336 <br /> MAILIN3 A.CDRESS CITY STATE ZIP <br /> 815 MOFFATT BLVD. MANTECA CA 95336 <br /> PHONE W/4P.EA CODE TYPE OF BUSINESS <br /> ( ) 01 GASOLINE STATION [X) 02 OTHER TRUCKING TERMINAL <br /> NUM3EP OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/A�RsEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> .209—A�*@q4* D 3 p Q 7 f 209—p�1� 7 <br /> COMPLETE THEFOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER FCOINTAINER NUM=MER #1 <br /> B. MANUFACTURER (IF APPROFRIATE): YEAR MFG: C. YEAR INSTALLED 1982 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS [ l 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 ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED E l 02 REGULAR f ) 03 PREMIUM (X) 04 DIESEL f ] 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: [ ) GAUGE f ] INCHES [ 1 CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON—VAULTED [ ) 03 UNKNOWN <br /> C. ( 1 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CAREON STEEL ( l 02 STAINLESS STEEL ( ] 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE C ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD E ) 08 BRONZE ( 1 09 COMPOSITE f ) 10 NON—METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 1 <br />