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STATE ID NUMBER 00000057927002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 17' 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> STATE MILITARY DEPT 4"STAtt—S' ( ) 01 FED f 1 02 STATE ( ) 03 LOCAL <br /> SSTREET ADDRESS p p CITY STATE ZIP <br /> :REET ADDRESIIS' �, U SACRAMENTO CA 95821 <br /> II FACILITY <br /> FACILITY NAME 'DEALER/FOREM.AN/SUPERVISOR <br /> WAb-a4At31Pr 3RDlr7YE4 O Zjqf <br /> STREET ADDRESS NEAREST CROSS STREET <br /> Qlo f `j/�' ;sf�p/ AIRPORT WAY STINSON <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE ZIP <br /> WQ, �'� Yt STOCKTON CA 95206 <br /> PHONE W/AREA CODE_ _ TYPE OF BUSINESS <br /> 209-482-44W - ( ) Ol GASOLINE STATION (X) 02 OTHER MAINT SHOP/FUEL STOP <br /> NUMBER O-F/CO NTAINEPS RURAL OWNSHIP RANGE SECTION <br /> d 0 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/6REA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE <br /> 209e&4-4aalt ygja 1 MARQUIS JOHN 209-463-9179 <br /> 5 b. So�W�ul4 <br /> C MPIFTF Tuc_ FOLLOkING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1956 ( l UNKNOWN <br /> D. CONTAINER CAPACITY: 5000 GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: ( 7 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (XI 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( l GAUGE ( l INCHES f ) CM (X) UNKNOWN <br /> B. f ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) !l-) 02 NON-VAULTED (4L),03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 1 02 SINGLE WALLED f l 03 LINED <br /> D. Q61-01 CARBON STEEL f l 02 STAINLESS STEEL ( 103 FIBERGLASS ( 104 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD ( 1 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> M 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070165 (10/18/85) PAGE 1 <br /> `OW —%EW <br />