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mil/ (I(S STATE ID NUMBER 00000000726004 <br />APPLICATION FOR PERMIT TO IERATEUUNDERGROUND STORAGE TANK <br />Fltl�'l <br />01 NEW PERMIT ( ) 05 RENEWED PERMIT (/\�' 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE <br />02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( f 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />(N'<ME(CCPPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />IM7ORE PETROLEUM ( l 01 FED ( ) 02 STATE ( ) 03 LOCAL <br />1STPEE7 ADDP-e SS CITY STATE ZIP <br />t;TH & F ST. (P.O. BOX 67) BANTA CA 95304 <br />I FACILITY <br />IFe;ILITY <br />(X) 01 TANK ( ) 04 <br />OTHER <br />NAME <br />CONTAINER <br />DEALEP./FOPEMAN/SUPERVISOR <br />FFANKS EXXON #2 <br />MANUFACTURER (IF APPROPRIATE): PERKINS <br />FRANK GUINTA <br />C. <br />YEAR INSTALLED 1968 [ ) UNKNOWN <br />D. <br />Sr--EET ADDPESS <br />500 GALLONS ( ) UNKNOWN <br />NE.AP.E T CROSS STREET <br />399 E. YOSEMITE AVE <br />DOES THE CCNTAINER <br />( ) 01 UNLEADED ( <br />oods <br />IO:TY <br />( 1 02 STAINLESS STEEL ( <br />( l 07 STEEL CLAD ( ) 08 <br />13 OTHER: <br />COUNTY <br />ZIP <br />MANTECA <br />SAN JOAQUIN <br />iM=:LING ADOFESS <br />CITY <br />STATE <br />ZIP <br />1399 E. YOSEMITE AVE <br />MANTECA <br />CA <br />95336 <br />PHONE W/A.PE.A CODE <br />TYPE OF BUSINESS <br />209-823-3313 <br />(X) 01 GASOLINE STATION ( l 02 OTHER <br />NUMBER OF CONTAINERS <br />RURAL APEAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />4 <br />III 24 HOUR EMERGENCY CONTACT PERSON <br />DAYS: NAME(LAST NAME FIRST) AND PHONE W/AP,EA CODE NIGHTS: N.AME(LAST NAME FIRST) .AND PHONE W/AREAA CODE <br />N9ERt-7B, R4�T 209-E_= _�_ M88REr T 209-948 Giz49 <br />L3- 3t k(h a <br />/COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 <br />OTHER <br />(X) GAUGE ( ) INCHES ( <br />CONTAINER <br />NUMBER 4 <br />B. <br />MANUFACTURER (IF APPROPRIATE): PERKINS <br />YEAR MFG: 1968 <br />C. <br />YEAR INSTALLED 1968 [ ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: <br />500 GALLONS ( ) UNKNOWN <br />E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br />F. <br />DOES THE CCNTAINER <br />( ) 01 UNLEADED ( <br />STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO <br />) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL <br />IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY <br />CONTAINMENT: 10 <br />(X) GAUGE ( ) INCHES ( <br />) CM ( ) UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) <br />(X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) 01 <br />DOUBLE WALLED <br />(X) 02 SINGLE WALLED ( <br />) 03 LINED <br />D. <br />(X) 01 <br />( ) <br />( ) 12 <br />CARBON STEEL <br />06 ALUMINUM <br />UNKNOWN ( ) <br />( 1 02 STAINLESS STEEL ( <br />( l 07 STEEL CLAD ( ) 08 <br />13 OTHER: <br />) 03 FIBERGLASS ( ) 04 <br />BRONZE ( l 09 COMPOSITE <br />POLYVINYL CHLORIDE ( ) 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) PAGE 1 <br />