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p" <br /> • STATE ID NUMBER 00000002264003 <br /> r APPLICATION FOR .PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> i 01 NEW. PERMIT - l 1 05 RENEWED PERMIT 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ND <br /> i 02 COITIONAL PERMIT [ ) 06 AMENDED PERMIT ( 08 MINOR CHANGE (NO SURCHARGE) <br /> OWNER <br /> ti:Y,EfCORPORATION.I NOIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ENS-ILLINOIS,INC., TRACY PLA ( ) 01 FED l 102 STATE ( ) 03 LOCAL <br /> ( THE!T ADDRESS CITY STATE ZIP <br /> 14706 W. SCHULTE ROAD TRACY CA 95376 <br /> ( <br /> S - FACILITY <br /> �ILITY NAME DEALER/FOREM.AN:SUPERVISOP <br /> ENS-ILLINOIS, INC. TRACY PLA ERNEST F. VALIS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> -14700 W. SCHULTE ROAD LAMMERS ROAD. <br /> C�2TY COUNTY ZIP <br /> 'MCY SAN JOAQUIN 95376 <br /> t: <br /> 4+ M.YIlLIL2N0 AOCRESS CITY STATE ZIP <br /> (A:O. BOX 30 TRACY CA 95376 <br /> .,PHONE W/AREA COO! TYPE OF BUSINESS <br /> k 209-835-5701 f I 01 GASOLINE STATION (X) 02 OTHER GLASS MANUFACTURING <br /> ti'JM`9 ER OF CONTAINERS RURAL AREAS ONLY TOWNSNIP RANGE SECTION <br /> 1 <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/AplA COO! <br /> ERNEST F. VALIS. 209-835-5701 ERNEST F. VALIS. 209-835-8626 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ( 1 01 TANK (X) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ( 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO - IF YES CHECK APPROPRIATE BOX(ES): <br /> 1 1 01 UNLEADED 1 ) 02 REGULAR ( 1 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 6 ( ) GAUGE (X) INCHES ( .) CM ( 1 UNKNOW! <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED 03�UNKNOWN <br /> C. 1 101 DOUBLE WALLED (X1 02 SINGLE WALLED 1 ) 03 LINED <br /> 0. ( 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL 1 1 03 FIBERGLASS [ ),04 POLYVINYL CHLORIDE (X) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 107 STEEL CLAD ( 1 08 BRONZE 1 ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) 12 Ut1KNOWN ( ) 13 OTHER: <br /> jihD4=070185 110/18/85) PAGE 1 <br /> - • w <br />