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STATE ID NUMBER 00000039023002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 1 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 3"02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAMI(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> STOCKTON GOLF AND COUNTRY CLUB f ] 01 FED l ) 02 STATE ( ) 03 LOCAL <br /> STREET AODP'-SS CITY STATE ZIP <br /> W COUNTRY CLUB BLVD. IS CA 95201 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMA /SUPERVS R <br /> STOCKTON GOLF AND COUNTRY CLUB i9H-3EPT:BN _AA <br /> STREET ADDPESS NEAREST CROSS STREET <br /> W COUNTRY CLUB BLVD. RAINIER <br /> CITY COEJOAQUIN <br /> ZIP <br /> STOCKTON SA95201 <br /> MAILING ADDRESSCITY STATE ZIP <br /> P.O. BOX 336 STOCKTCA 95201 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-4313 ( ) O1 GASOLINE STATION (X) 02 OTHER GOLF COURSE <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANG! SlCTION <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 /> yEpiBHT-T6M- 209-466-4313 I6RStm-1171'1 209-400-0157- <br /> M THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. IX) 01 TANK ( ) 04 OTHER: ICONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1981 ( ] UNKNOWN <br /> 0. CONTAINER CAPACITY: 1000 GALLONS f l 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 ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL l 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: l ) GAUGE ( I INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( l 01 DOUBLE WALLED ( ) 02 SINGLE WALLED l ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 104 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD [ ) 08 BRONZE ( 1 09 COMPOSITE f 1 10 NON-METALLIC <br /> [ 1 12 UNKNOWN f 1 13 OTHER: <br /> PAGE 1 <br /> HSC04-070185 (10/18/85) <br />