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STATE ID NUMBER 00000000726001 <br />APPLICATION FOR PERMIT TO OPER UZ"UNDERGROUND STORAGE TANK <br />01 NEW PERMIT ( ) 05 RENEWED PERMIT 07 TANK ( ) 09 DELETE FROM FILE (NO FEE) <br />02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( T_ MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />:AME(COFPOP.ATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />100RE PETROLEUM ( 1 01 FED ( l 02 STATE ( l 03 LOCAL <br />:TPEET ADDRESS CITY STATE ZIP <br />)TH & F ST. (P.O. BOX 67) BANTA CA 95304 <br />II FACILITY <br />FACILITY NAME <br />NAME FIRST) AND PHONE W/AREA CODE <br />DEALER/FOREMAN/SUPERVISOR <br />FRANKS EXXON #2 <br />W/AREA CODE <br />FRANK GUINTA <br />STREET ADDPESS <br />MANUFACTURER (IF APPROPRIATE): <br />NEAREST CROSS STREET <br />1399 E. YOSEMITE AVE <br />G a t c1 , <br />N6 <br />`J n <br />r T V - <br />CITY <br />CONTAINER STORE: ( <br />COUNTY <br />ZIP <br />M.ANTECA <br />STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL <br />SAN JOAQUIN <br />IF YES CHECK APPROPRIATE BOX(ES): <br />f ) 06 OTHER <br />MAILIN3 ADDRESS <br />CITY <br />STATE <br />ZIP <br />1399 E. YOSEMITE AVE <br />MANTECA <br />CA <br />95336 <br />PHCNE W/AF.EA CCDE <br />TYPE OF BUSINESS <br />209-823-3313 <br />(X) 01 GASOLINE STATION ( ) 02 OTHER <br />NUMSEP OF CONTAINERS <br />RURAL .AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />)AYS: N.AME(LAST <br />NAME FIRST) AND PHONE W/AREA CODE <br />OTHER: <br />NIGHTS: NAME(LAST NAME FIRST) AND PHONE <br />W/AREA CODE <br />RY <br />209-om=rav-, <br />MANUFACTURER (IF APPROPRIATE): <br />209-948-e�?49 <br />YEAR MFG: 1968 <br />G a t c1 , <br />f� 23"a- 3— 3 <br />`J n <br />CbMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( 1 04 <br />OTHER: <br />) CM ( ) UNKNOWN <br />CONTAINER <br />NUMBER 1 <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />PERKINS <br />YEAR MFG: 1968 <br />C. <br />YEAR INSTALLED 1968 ( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: <br />8000 GALLONS ( ) UNKNOWN <br />JE. DOES THE <br />CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER <br />(X) 01 UNLEADED ( <br />STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL <br />01 YES ( ) 02 NO <br />( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />f ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: 1/4 <br />( ) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( ) <br />01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) <br />01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( <br />l 03 LINED <br />D. <br />(X) <br />( ) <br />01 <br />( ) <br />12 <br />CARBON STEEL ( l 02 STAINLESS STEEL ( <br />06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 <br />UNKNOWN ( ) 13 OTHER: <br />) 03 FIBERGLASS ( l 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( l 10 NON-METALLIC <br />HSC04-070185 (10/18/85) PAGE 1 <br />