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STATE I0 NUMBER 00000009547001 <br />APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br />l� <br />01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />1{=7 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br />I OWNER <br />NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br />GENE GABBARD INC. I ( ) 01 FED ! ) 02 STATE f 1 03 LOCAL <br />STREET ADDRESS j CITY STATE ZIP <br />640 N. EL DORADO STOCKTON CA 95202 <br />TT FACTLITV <br />FACILITY NAME <br />(X) 01 TANK ( ) 04 <br />DEALER/FOREMAN/SUPERVISOR <br />( ) CM (X) UNKNOWN <br />GENE GABBARD INC. <br />B. <br />JIM GABBARD <br />FX* 03 UNKNOWN <br />STREET ADDRESS <br />C. YEAR INSTALLED (X) UNKNOWN <br />NEAREST CROSS STREET <br />CONTAINER CAPACITY: <br />640 N. EL DORADO <br />E. DOES THE CONTAINER STORE: (X) 01 WASTE ( 1 02 PRODUCT <br />PARK <br />DOES THE CONTAINER <br />( 1 01 UNLEADED ( <br />CITY <br />POLYVINYL CHLORIDE f ) 05 CONCRETE <br />l 1 10 NON-METALLIC <br />COUNTY <br />ZIP <br />STOCKTON <br />SAN JOAQUIN <br />95202 <br />MAILING ADDRESS <br />CITY <br />STATE <br />ZIP <br />P.O. BOX 1260 <br />STOCKTON <br />CA <br />95201 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-464-7671 <br />( ) 01 GASOLINE STATION (X) 02 OTHER AUTO DEALER <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />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/ARCA CODE <br />GABBARD, JIM 209-464-7671 <br />COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 <br />OTHER: <br />( ) CM (X) UNKNOWN <br />CONTAINER NUMBER 1 <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />FX* 03 UNKNOWN <br />YEAR MFG: <br />C. YEAR INSTALLED (X) UNKNOWN <br />D. <br />CONTAINER CAPACITY: <br />L.5ZL GALLONS (.X4 UNKNOWN <br />E. DOES THE CONTAINER STORE: (X) 01 WASTE ( 1 02 PRODUCT <br />F. <br />DOES THE CONTAINER <br />( 1 01 UNLEADED ( <br />STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL f 1 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: <br />( ) GAUGE ( ) INCHES <br />( ) CM (X) UNKNOWN <br />B. <br />( ) 01 VAULTED (LOCATED <br />IN AN UNDERGROUND VAULT) Q(.1. 02 NON -VAULTED <br />FX* 03 UNKNOWN <br />C. <br />( ) 01 DOUBLE WALLED ( <br />) 02 SINGLE WALLED f <br />1 03 LINED <br />D. <br />(J�01 CARBON STEEL l <br />( ) 06 ALUMINUM l ) <br />Hh) 12 UNKNOWN ( ) 13 <br />1 02 STAINLESS STEEL f <br />07 STEEL CLAD ( ) 08 <br />OTHER: <br />1 03 FIBERGLASS f ] 04 <br />BRONZE ( ) 09 COMPOSITE <br />POLYVINYL CHLORIDE f ) 05 CONCRETE <br />l 1 10 NON-METALLIC <br />HSC04-070185 (10/18/85) PAGE I <br />a <br />