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STATE ID NUMBER 00000057927001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> f 1 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COP.PORATION,iNDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> STATE MILITARY DEPT 349T'At:t. B ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET AOORESR /)pp Q CITY STATE ZIP <br /> Op�7JZff <br /> C ( SACRAMENTO CA 95821 <br /> II FACILITY <br /> FACILITY NAM'- DEALER/FOREMAN/SUPERVISOR <br /> f2l.MSOMAt-PtA2NT�1iWOA-NZ�' - VIE!/ � �- M58 B*V?65 k!. 194+LE4RER <br /> _ .- <br /> STREET AD^v PFSSOfbf ° Al, f AIRPORT CROSS STREET <br /> 64&0-SGR4*H--Al*P0Rf WAY <br /> > $ J AIRPORT WAY STIMSON <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS y � 5, CITY STATE ZIP <br /> F <br /> 'F STOCKTON CA 95206 <br /> PHONE W/APEA CODE TYPE OF BUSINESS <br /> 209-982-4416 ( ) 01 GASOLINE STATION (X) 02 OTHER MAINT SHOP/FUEL STOP <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 0 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NA ME(LAST NAME FIRST) AND PHONE W/AP.EA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> MARQUIS JOHN 209-463-9179 <br /> (? ToNAj 1E FOLLOWING 04 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: I C. YEAR INSTALLED ftlo HH UNKNOWN <br /> 0. CONTAINER CAPACITY: 10000 GALLONS ( 1 UNKNOWN "S THE CONTAINER STORE: l ) 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 /> (X) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( 1 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( l INCHES f ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f 02 NON-VAULTED 1+41 03 UNKNOWN <br /> C. f l 01 DOUBLE WALLED ( ) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ()6 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> �( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f 109 COMPOSITE ( l 10 NON-METALLIC <br /> CX'T 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />