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`* ..01 <br />APPLICATION FOR PERM--Tr rn— n—a• r—a• �Ar• r )v(.n(„L,�en.. 1. STATE ID NUMBER <br />R 00000058665002 <br />unUUNu ___RAG_ <br />1 OWNER <br />NAME(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) <br />STOCKTON UNIFIED SCHOOL DISTRI <br />STREET ADDRESS <br />701 NORTH MADISON ST. <br />II FACILITY <br />PUBLIC AGENCY ONLY <br />( l 01 FED ( ) 02 STATE Wf 03 LOCAL <br />CITY STATE ZIP <br />STOCKTON CA 95202 <br />(X) 01 TANK ( ) 04 OTHER: <br />iKsf D" <br />TANK <br />litt 01 NEW PERMIT <br />' ( ) 02 CONDITIONAL PERMIT <br />( ) 05 RENEWED <br />( ) <br />PERMIT <br />( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br />HIGH SCHOOL <br />06 AMENDED <br />PERMIT <br />( ) 08 MINOR CHANGE (NO SURCHARGE) <br />1 OWNER <br />NAME(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) <br />STOCKTON UNIFIED SCHOOL DISTRI <br />STREET ADDRESS <br />701 NORTH MADISON ST. <br />II FACILITY <br />PUBLIC AGENCY ONLY <br />( l 01 FED ( ) 02 STATE Wf 03 LOCAL <br />CITY STATE ZIP <br />STOCKTON CA 95202 <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 />RU58Ett, B. 209-944 "" IVln SAME - <br />2j9lA(o[L) 6 jw�AC 4 <br />ern-cEJ C !ME rULLUWInG UM A St:YARAIL FORM FUR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />iKsf D" <br />60A) i4C <br />FACILITY NAME Sus <br />MANUFACTURER (IF APPROPRIATE): <br />le. <br />C. YEAR INSTALLED 1979 ( ) UNKNOWN <br />HIGH SCHOOL <br />CONTAINER CAPACITY: 500 GALLONS ( ) UNKNOWN <br />E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br />D. <br />,1 <br />BILL RUSSELL i%iM'Cc*_ Isf Ahh hq�y,c�j <br />STREETEDISON <br />STREET ADDRESS <br />) 03 FIBERGLASS f 7 04 POLYVINYL CHLORIDE ( 105 CONCRETE <br />BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br />1425 S. CENTER <br />NEAREST CROSS STREET <br />CHARTER WAY <br />CITY <br />STOCKTON <br />COUNTY <br />IIP <br />SAN JOAQUIN <br />95206 <br />MAILING AODR!SS <br />1932 H. EL PINAL <br />CITY <br />STATE <br />ZIP <br />STOCKTON <br />CA <br />95205 <br />PHONE W/AREA CODE <br />TYPE OF BUSINESS <br />209-944-4412 <br />•I' <br />( ) O1 GASOLINE STATION (0 02 OTHER 7413 k <br />NUMBER OF CONTAINERS <br />RURAL AREAS ONLY <br />TOWNSHIP <br />RANGE <br />SECTION <br />2 <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 />RU58Ett, B. 209-944 "" IVln SAME - <br />2j9lA(o[L) 6 jw�AC 4 <br />ern-cEJ C !ME rULLUWInG UM A St:YARAIL FORM FUR EACH CONTAINER <br />IV DESCRIPTION <br />A. <br />(X) 01 TANK ( ) 04 OTHER: <br />( ) GAUGE ( ) INCHES ( <br />CONTAINER NUMBER 2 <br />B. <br />MANUFACTURER (IF APPROPRIATE): <br />YEAR MFG: <br />C. YEAR INSTALLED 1979 ( ) UNKNOWN <br />D. <br />CONTAINER CAPACITY: 500 GALLONS ( ) UNKNOWN <br />E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br />F. <br />DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br />( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br />V CONTAINER CONSTRUCTION <br />A. <br />THICKNESS OF PRIMARY CONTAINMENT: <br />( ) GAUGE ( ) INCHES ( <br />I CM (X) UNKNOWN <br />B. <br />( ) <br />01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON -VAULTED ( <br />) 03 UNKNOWN <br />C. <br />( ) <br />01 DOUBLE WALLED (X) 02 SINGLE WALLED ( <br />1 03 LINED <br />D. <br />(X) <br />f <br />( l <br />01 CARBON STEEL f ) 02 STAINLESS STEEL ( <br />) 06 ALUMINUM 1 ) 07 STEEL CLAD ( ) OB <br />12 UNKNOWN ( ) 13 OTHER: <br />) 03 FIBERGLASS f 7 04 POLYVINYL CHLORIDE ( 105 CONCRETE <br />BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br />HSC04-070185 (10/18/85) <br />PAGE 1 <br />