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n_ ��, u�Z��� STATE ID NU118 ER 00000017796004 <br /> APPLICATION FOR PERMIT T OPERATE UN ERG 0 ND STORAGE TANK <br /> 1 ) O1 NEW PERMIT f ) 05 RENEWED PERMIT (I'Ci 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE1 <br /> 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT f 108 MINOR C E (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> HOLT BROS. ( ) 01 FED ( ) 02 STATE ( ! 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1521 WEST a"EST:' WAY STOCKTON CA 95206 <br /> II FArILITY <br /> FACILITY NAME DEALER/FOREMAN/S PERVISOR <br /> HOLT BROS. D„VM8;Fr <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1521 WEST GftESTM WAY INTERSTATE HWY 5 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> P.O. BOX 8130 STOCKTON CA 95208 <br /> PHONE W/AREA CODE TYPE OF BUSINESS ,/ <br /> 209-466-6000 ( ) 01 GASOLINE STATION (X) 02 OTHER FARM tp /(Aria <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LA.ST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> 209-466-6000 z Q <br /> 19 <br /> &mv <br /> OMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER- CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: J GALLONS (•Xi 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 ( ) 03 PREMIUM (X) 04 DIESEL l ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) j4_02 NON—VAULTED WT 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f ) 03 LINED <br /> 0. 6j_01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> —c ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE ( 1 10 NON—METALLIC <br /> (iH 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> 1P' �r <br />