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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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�► -- "' STATE ID NUMBER 00000011982005 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 1 01 NEW PERMIT ( ] 05 RENEWED PERMIT ( ) 07 TANK CLOSED ) 09 DELET (u^ FFF] <br /> l 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> WOOLSEY OIL INC. ( ) 01 FED ( ) 02 STATE 1 ] 03 LOCAL <br /> STREET ADDRESS CITY STAT[ ZIP <br /> 166 FRANK WEST CR. STOCKTON CA 95231 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOR.EMAN/SUPERVISOR <br /> WOOLSEY OIL INC. <br /> STREET ADOPESS NEAREST CROSS STREET <br /> 3686 W. COUNTRY CLUB COUNTRY CLUB i 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/APEA 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 /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(IAST NAME FIRTT) AND PHONE W/AREA CODE [NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AR[A CODE <br /> WOOLSEY BRUCE 209-334-0552 W00 LSEY BRUCE 209-334-0652 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK f ) 04 OTHER: CONTAINER NUMBER BW 2 <br /> B. MANUFACTURER (IF APPROPRIATE): ACE YEAR MFG: 1982 C. YEAR INSTALLED 1982 1 1 UNKNOWN <br /> D. CONTAINER CAPACITY: .4.� GALLONS ( ] UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( 1 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (,X) 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER . <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 10 (X) GAUGE f ) INCHES ( ) CM ( 1 UNKNOWN <br /> B. ( 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) 1X1 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ] 03 LINED <br /> 0. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE [ ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />
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