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STATE IO NUMBER 00000059367003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> t*01 NEW PERMIT ( ) 05 RENEWED PERMIT f ) 07 TANK CLOSED f ) 09 DELETE FROM FILE (NO FEE) <br /> ) 02 CONDITIONAL PERMIT [ ! 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPCRATION. NO SVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> J,R-SiWRLBP- �u ,� �YD ( ) 01 FED f ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS / CITY �^ STATEn r1 <br /> 15L_LL�3R0-9T. /1 74i <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERyISOR <br /> SI74RLoz-SuLauzu RS Are Gry RnRcRT (`ATTCV 6 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1904 W. CHARTER WAY 1-5 <br /> CITY COUNTY IIP /;S2 a <br /> STOCKTON SAN JOAQUIN .95204r- <br /> MAILING ADDRESS // �q CITY STATE IIP f,SZOG <br /> . U. $OX t/(/0 O / STOCKTON CA <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-464-430& 2�/(> �jb 1061 ( 1 01 GASOLINE STATION (X) 02 OTHER AG CHEM DISTR. <br /> NUMBER OF CONTAS NE RS 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) A;4.0 PHONE W/9 EA CODE <br /> &A7TRY, onaEU 209-95t-*46r SAME <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3980t- <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE tX) 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 ( ) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: l ) GAUGE ( 1 INCHES f I CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) l ) 02 NON-VAULTED fX) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) Cl CARBON STEEL ( ) 02 STAINLESS STEEL ( ! 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD ( l 08 BRONZE ( 1 09 COMPOSITE f 110 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 t10/18/85) PAGE 1 <br />