Laserfiche WebLink
STATE ID NUMBER C0000012403003 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />NO FEE <br />) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( l 07 TANK CLOSED ( ) 09 DELETE FROM FILE (L <br />Q ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPORATION,INDIVIDUAL OR PUBLIC AG!NCY) PUBLIC AGENCY ONLY <br />THE SOUTHLAND CORPORATION ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br />STREET ADDRESS7cp <br />IT`r STATE F94566 <br />P <br />5820 STONERIDGE MALL ROAD, #31 LEASANTON CA <br />II FACILITY <br />FACILITY NAME <br />THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( <br />DEALER/FOREM.AN/SUPERVISOR <br />B. <br />7 -ELEVEN FOOD STORE 2243-19976 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />DENNIS & JAN ESENWEIN <br />C. <br />STREET ADDRESS <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br />NEAREST CROSS STREET <br />D. <br />1399 N. MAIN STREET <br />CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 <br />06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE <br />UNKNOWN ( ) 13 OTHER: <br />NORTHGATE <br />CITY <br />COUNTY <br />ZIP <br />MANTECA <br />SAN JOAQUIN <br />95336 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />2937 VENEMAN ROAD <br />MODESTO <br />CA <br />95356 <br />PHONE W/APE.A CODE <br />TYPE OF BUSINESS <br />209 -&;a -9t'2, — Ti7r� <br />(X) 01 GASOLINE STATION ( ) 02 OTHER <br />NUMBER. OF CONTAINERS <br />RURAL AREAS ONLYTOWNSHIP <br />RANGE <br />SECTION <br />3 <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/AREA CODE <br />TOM EFAW 209-578-9716 TOM EFAW 209-527-0870 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. (X) 01 TANK ( ) 04 OTHER: <br />CONTAINER NUMBER -1997'6-3 <br />B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: I C. YEAR INSTALLED 1977 ( ) UNKNOWN <br />D. CONTAINER CAPACITY: 6000 GALLONS ( ) 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 ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 01 UNLEADED ( ) 02 REGULAR (X) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( <br />) CM (X) UNKNOWN <br />B. <br />( ) 01 <br />VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( } 01 <br />DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br />D. <br />(X) 01 <br />( ) <br />( ) 12 <br />CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( l 04 <br />06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE <br />UNKNOWN ( ) 13 OTHER: <br />POLYVINYL CHLORIDE ( l 05 CONCRETE <br />( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) PAGE 1 <br />