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OpSTATE 20 NUMBER 00000017798010 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> lyJ 01 NEW PERMIT ( ) 05 RENEWED PERMIT (X1 07 TANK Qul3m ( ) 09 DELETE FROM FILE (NO FEE) <br /> I"7 02 CONDITIONAL PERMIT ( 106 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAMIfCOPPORATION.INDIVIDUAL OR PUBLIC AGENCY) CLIC AGENCY ONLY <br /> HOLT BROS. ( ) 01 FED f 1 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 1521 WEST Gl ISSTERWAY STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/S PlRVISOR <br /> HOLT BROS. _ <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1521 WEST 6WESM 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 FQZ[4*43r r . <br /> NUMBER OF CO NTAIN!PS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <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 COO! <br /> DAVID T. MOTT 209-466-6000 <br /> (5 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 10 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> 0. CONTAINER CAPACITY: '76 010 GALLONS M UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE 80X(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( l 05 WASTE OIL 122 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ] INCHES f I CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) �C) 02 NON-VAULTED HFT 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( ) 03 LINED <br /> 0. (X.) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> �T ( ) 06 ALUMINUM f ) 07 STEEL CLAD l 1 08 BRONZE f ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> Wtr 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> L/ �I <br />