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BILLING_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0504662
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BILLING_PRE 2019
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Entry Properties
Last modified
3/22/2021 10:08:19 PM
Creation date
11/2/2018 6:59:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
PRE 2019
RECORD_ID
PR0504662
PE
2381
FACILITY_ID
FA0006276
FACILITY_NAME
THABET M KARABALA MD
STREET_NUMBER
3686
Direction
W
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12103036
CURRENT_STATUS
02
SITE_LOCATION
3686 W COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\C\COUNTRY CLUB\3686\PR0504662\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
11/7/2012 8:00:00 AM
QuestysRecordID
113518
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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x��cpT <br /> STATE ID NUMBER 001100011982004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT f ) 05 RENEWED PERMIT f ) 07 TANK CLOSED 04 09 DELETE FROM FILE (NO FEEL <br /> ( ) 02 CONDITIONAL PERMIT ( ] 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WOOLSEY OIL INC. ( ) Ol FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 166 FRANK WEST CR. STOCKTON CA 95231 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> WOOLSEY OIL INC. <br /> STREET ADDPESS NEAREST CROSS STREET <br /> 3686 W. COUNTRY CLUB COUNTRY CLUB A I-5 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 166 FRANK WEST CR. STOCKTON CA 95231 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-9412 ( ) 01 GASOLINE STATION (X) 02 OTHER HOME <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> a3 <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 CODE <br /> WOOLSEY BRUCE 209-334-0652 WOOLSEY BRUCE 209-334-0652 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER BW 1 <br /> B. MANUFACTURER (IF APPROPRIATE): ACE YEAR MFG: 1983 C. YEAR INSTALLED 1983 1 ) UNKNOWN <br /> D. CONTAINER CAPACITY: $_J-0 GALLONS ( 1 UNKNOWN E. GOES THE CONTAINER STORE: ( l 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 BOX(ES): <br /> ( ) 01 UNLEADED f ) 02 REGULAR f ) 03 PREMIUM f ) 04 DIESEL ( 1 05 WASTE OIL f l 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE f ) INCHES ( ) CM ( 1 UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON—VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL f 1 02 STAINLESS STEEL ( l 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ] 07 STEEL CLAD t ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON—METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> Li ".ol <br />
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