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STATE IO NUMBER 00000057239001 <br /> APPLICATION FOR PERMIT TO qfERATE UNDERGROUND STORAGE TANK <br /> 0 <br /> 1 NEW PERMIT f ) 05 RENEWED PERMIT 07 TANK CLOSED f 1 09 DELETE FROM FILE (NO FEE) <br /> )-02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> 01 FED ( 1 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS ,�^ CITY STATE ZIP <br /> � <br /> iX 41*7T 4VIFr, STOCKTON CA 95206 <br /> II FACILITY �,�'�y//��L y� <br /> FACILITY NAME CE W/,+ �CY�UA7v�� DEALERD BALER/F OAR EMAN/SVPC RNLI OR rr_ .y/ <br /> STREET ADDRESSq� NEAREST CROSS STREET <br /> ootOy, ('r- STIMPSON <br /> CI7Y COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS p L ,/�� 'y, CITY STATE ZIP <br /> 5R h /71AC.,L STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-982-4544 ( ) 01 GASOLINE STATION (X) 02 OTHER WAST OIL STORAGE <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA//C,.CDDEEE NIGHTS: NAME(LAST NAME FIPST) AND PHONE W/AREA COD <br /> Det--JDIMH:-NBtkM' 2 0 9 1473-645T QS;t_te T/ 209-03-84i�`r,7 <br /> p <br /> COMPLET HE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER R1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1956 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: &do ww GALLONS ( 1 UNKNOWN E. ODES THE CONTAINER STORE: (X) 01 WASTE l 1 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTEOIL 7 ( ) 01 YES (X) 02 NO IF YES CHECKAPPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL 05 WASTE OIi ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE ( ) INCHES ( ) CM (X1 UNKNOWN <br /> S. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. A l 01 DOUBLE WALLED f ) 02 SINGLE WALLED ( ) 03 LINED <br /> 0. ( ) 01 CARBON STEEL f 1 02 STAINLESS STEEL ( 103 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( S 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE l ) 10 NON-METALLIC <br /> 4X-1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />