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�/2��0 C STATE ID NUMBER 00000017798005 <br /> APPLICATIDN FOR PERMIT TO OPERATE UNDER ROUND STORAGE TANK <br /> (x_01 NEW PERMIT ( 1 05 RENEWED PERMIT T IK � ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT f OB MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> HOLT BROS. ( 1 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 1521 WEST 4WfSffR WAY STOCKTON CA 95206 <br /> cowt <br /> I I F Ator IFT Y__ <br /> FACILITY NAME DEALER/FOREMAN/S FRVISOR <br /> HOLT BROS. BAy'Eg- -MB{.f, 1/lµ/' <br /> ITREET ADDRESS NEAREST CROSS STREET <br /> 1521 WEST+nESFER WAY INTERSTATE HWY 5 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX 8130 STOCKTON CA 95208 <br /> PMONE W/APEA CODE TYPE OF BUSINESS <br /> 209-466-6000 ( ) 01 GASOLINE STATION (X) 02 OTHER FARM (Q(((om <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> LAKI9-T:-"8T-:FL ff��CC 209-466-6000 KL - <br /> �CIIMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f 1 04 OTHER: CONTAINER NUMBER 5 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: ?:!EQ GALLONS rK-) UNKNOWN E. DOES THE CONTAINER STORE: f ) 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 /> ( ) <br /> 01 UNLEADED ( ) 02 REGULAR f 1 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> 8. l l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 02 NON-VAULTED NOLO 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED ( ! 02 SINGLE WALLED ( ) 03 LINED <br /> D. (_t 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM t ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( l 30 NON-METALLIC <br /> (91, 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/16/85) PAGE 1 <br /> `r \e <br />