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STATE ID NUMBER 00000039023001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 01 NEW PERMIT f ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATION,INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> STOCKTON GOLF AND COUNTRY CLUB ( ) 01 FED f ) 02 STATE f 1 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> W COUNTRY CLUB BLVD. STOCKTON CA 95201 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREM N/SUPERV <br /> STOCKTON GOLF AND COUNTRY CLUB L <br /> STREET ADDRESS NEAREST CROSS STREET <br /> W COUNTRY CLUB BLVD. RAINIER <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95201 <br /> MAIL-N3 ADDRESS CITY STATE ZIP <br /> P.O. BOX 336 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-4313 f ) 01 GASOLINE STATION (X) 02 OTHER GOLF COURSE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <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 /> CH 209-*w.A0W,gW— t13( de�ee s 209- 'y <br /> pUN. L <br /> C PLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES f 7 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) INCHES ( ) CH (X) UNKNOWN <br /> B. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( 1 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL [ ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE 1 ) OS CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE f l 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />