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�IN� (bl STATE ID NUMBER 00000000726002 <br />APPLICATION FOR PERMIT TO OP E UNDERGROUND STORAGE TANK <br />01 NEW PERMIT ( ) 05 RENEWED PERMIT ( TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT C-) 08 MINOR N (NO SURCHARGE) <br />I OWNER <br />4AME(COPPOPATION,INDIVIDU.AL OR PUBLIC .AGENCY) PUBLIC AGENCY ONLY <br />100RE PETROLEUM ( ) 01 FED [ ) 02 STATE ( l 03 LOCAL <br />;TPEET ACORESS CITY STATE ZIP <br />>TH & F ST. (P.O. BOX 67) BANTA CA 95304 <br />II FACILITY <br />FACILITY NAME <br />FIRST) .AND <br />DEALER,/FOREMAN/SUPERVISOR <br />FRANKS EXXON #2 <br />NIGHTS: N.AME(LAST NAME <br />FRANK GUINTA <br />STREET ADDRESS <br />209-&46-1450— <br />NEAREST CROSS STRE T <br />1399 E. YOSEMITE AVE <br />MOORE, EQQe <br />r S <br />CITY <br />CONTAINER STORE: ( <br />COUNTY <br />ZIP <br />MANTECA <br />01 YES ( ) 02 NO <br />( ) 05 WASTE OIL <br />SAN JOAQUIN <br />MAILING ACDPESS <br />CITY <br />STATE <br />ZIP <br />1399 E. YOSEMITE AVE <br />MANTECA <br />CA <br />95336 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-823-3313 <br />(X) 01 GASOLINE STATION ( ) 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLI' <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME <br />FIRST) .AND <br />PHONE W/AREA CODE <br />CONTAINER <br />NIGHTS: N.AME(LAST NAME <br />FIRST) .AND PHONE W/AREA CODE <br />MANUFACTURER (IF APPROPRIATE): PERKINS <br />209-&46-1450— <br />C. <br />YEAR INSTALLED (X) UNKNOWN <br />MOORE, EQQe <br />209-W+g-n749 - <br />u(vL <br />CONTAINER STORE: ( <br />a- 3- - <br />urn z, rA� <br />3 - <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM'FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />) CM ( ) UNKNOWN <br />CONTAINER <br />NUMBER 2 <br />B. <br />MANUFACTURER (IF APPROPRIATE): PERKINS <br />YEAR MFG: <br />C. <br />YEAR INSTALLED (X) UNKNOWN <br />D. <br />CONTAINER CAPACITY: ia GALLONS ( 1 UNKNOWN <br />E. DOES THE <br />CONTAINER STORE: ( <br />) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) <br />( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL <br />01 YES ( ) 02 NO <br />( ) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: 1/4 ( ) GAUGE (X) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED t <br />) 03 UNKNOWN <br />C. <br />( l 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br />D. <br />(X) 01 <br />( ) <br />( ) 12 <br />CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 <br />06 ALUMINUM ( l 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE <br />UNKNOWN ( ) 13 OTHER: <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) PAGE 1 <br />