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STATE IO NUMBER 00000061457001 <br /> """"��,��`��/��/ """" APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 NEW PERMIT ( 1 05 RENEWED PERMIT ( 1 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATZON.ZNDIVIDUAL 09 PUSLIC A2�N17 PUBLIC AGENCY ONLY <br /> ( ) <br /> 01 FED f ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY `/ STA79 ZIP <br /> HCit-j'9RR//(ll 7 <br /> II FACILITY <br /> FACILITY NAME r DEALER/FOREMAN/SUPERVISOR <br /> 8r'ER*%S-NEW HOLLAND yN. CHARLES IKER <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 2150 W. CHARTER WAY TELLIE LEWIS DR. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE 2IP <br /> P.O. BOX 6219 STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-948-5401 ( ) 01 GASOLINE STATION fX) 02 OTHER FARM EQUIPMENT <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME FIRST) AND PHONE W/AREA CODE <br /> NAME(LAST <br /> CHARLES IKER 209-948-5401 5 209-948-5401 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 26674 <br /> S. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1974 ( ] UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS [ I UNKNOWN E. HOES THE CONTAINER STORE: ( 1 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 /> S ) 01 UNLEADED f l 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 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 ( l 02 SINGLE WALLED f 103 LINED <br /> 0. tO1 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE f ] 10 N(N!-METALLIC <br /> HH 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />