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�� STATE I0 NUMBER 00000059367004 <br /> � E U <br /> APPLICATION FOR PERMIT TO OPERNDERGROUND STORAGE TANK <br /> Fk ,01 NEW PERMIT ( ) 05 RENEWED PERMIT (y ( )A9 DELETE FROM FILE..(NO FEE) <br /> l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT f 1 0808 MIN (NO SURCHARGEr <br /> I OWNER <br /> NAME)CO P.PO P.ATION,INZVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> ( 1 <br /> 01 FED ( ) 02 STATE f ) 03 LOCAL <br /> Gyre _ <br /> STATE <br /> STREET eD04ES5 ZIP 9S 69/ <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> GIC fro RMMT ,.� y Taub <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1904 W. CHARTER WAY 1-5 <br /> CITY - COUNTY ZIP 610 <br /> STOCKTON SAN JOAQUIN <br /> i CITY STATE ZIP <br /> MAILING ADDRESS <br /> o, (3OX STOCKTON CA <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 260-444.i32(>- ��d l/� f(lj �,�Dy/ ( ] 01 GASOLINE STATION (X) 02 OTHER AS CHEM DISTR. <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> lAY3* NAMEILAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(IAST NAME FIRST) AND PHONE W/AREA CODE <br /> SAME — — C <br /> _--COMPLETE E FOLL ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER TOOOY <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1981 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: - 7 1 000 GALLONS ( ) 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 I ) 02 NO IF YES CHECK APPROPRIATE BOX(ESI: <br /> 1 ) 01 UNLEADED (-.) 02 REGULAR f ) 03 PREMIUM !1O 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) 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 ( 1 03 LINED <br /> D. 1 ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE 1 1 05 CONCRETE <br /> ( ) 06 ALUMINUM (X) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( l 10 NON-METALLIC <br /> f 1 12 UNKNOWN ( ) 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br /> i <br />