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'11 <br /> �� STATE ID NUMBER 00000055190002 <br /> APPLICATION FOR PE MIT TO OPER T UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT f 7 05 RENEWED PERMIT 01 07 TANK CLOSED 104'" (,)d 09 DELETE FROM FILE (NO FEE) <br /> ( ] 02 CONDITIONAL PERMIT t l 06 AMENDED PERMIT _) 08 MINOR CHANGE (NO SURCHARGE <br /> I OWNER <br /> NAM.EICORPOPATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> END DISTRICT AGRICULTURAL ASSO ( ) O1 FEO ( ) 02 STATE ( ) 03 LOCAL <br /> STREET AODFESS CITY STATE ZIP <br /> 1658 SOUTH AIRPORT WAY STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SAN JOAQUIN COUNTY FAIR JACK FLINT, <br /> STREET ADCRESS NEAREST CROSS STREET <br /> 1658 SOUTH AIRPORT WAY CHARTER <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> P.O. BOX 6310 STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-5041 ( ) 01 GASOLINE STATION (X) 02 OTHER FAIR GROUNDS <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 2 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAY,E(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> FLINTS JACK 209-466-5041 SAME - - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1960 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 GALLONS ( 1 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 ( ) 02 REGULAR (X) 03 PREMIUM f ) 04 DIESEL f ) 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) 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 (X) 02 SINGLE WALLED f ] 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL [ 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />