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STATE I0 NUMBER 00000059367001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> P01 NEW PERMIT ( ) O5 RENEWED PERMIT ( ) 07 TANK CLOSED (. ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGH <br /> I OWNER <br /> NAME(CORPORATION,I DIVIDUA OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> are is ( ) 01 FED ( 102 STATE ( ) 03 LOCAL <br /> STREET ADDRESSCITY sTATE� ZIP S / <br /> /27GL/ Ilel <br /> // <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUP! VISOR <br /> SIMPIOT � 4ry w&64T-6AifiEY rjd XV7err6+- <br /> STPE!T ADDRESS NEAREST CROSS STREET <br /> 1904 W. CHARTER NAY I-5 <br /> CITY COUNTYZIP <br /> STOCKTON SAN JOAQUIN Die293- �7 <br /> MAILING ADDRESS PaCITY STATE ZIP <br /> G �y <br /> p�0_ eox 90Z �(�OO STOCKTON CA ww <br /> PHONE W/AP.EA CCQE TYPE OF BUSINESS <br /> 284464-&32'B—�tO�J V/ ( 1 01 GASOLINE STATION (X) 02 OTHER AG CHEM DISTR. <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/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W(A1REA CODE <br /> CAIIFY�J9iERf 20993i 4 67 SAME C7/ <br /> y c 9"/"'— <br /> ----- �bMPLETE THE FOLLOWIN ON A SEPARATE FORM FOR EACH CONTAINER <br /> . IV DESCRIPTION <br /> A. fX) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 18983E <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS f I 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 l7F4 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f 7 05 WASTE OIL f ! 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ) 03 LINED <br /> D. ( ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS l 104 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> H\SC04-070185 (10/18/85) PAGE 1 <br />