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' STATE ID NUMBER 00000057927003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( <br /> 1 01 NEW PERMIT ( ) 05 RENEWED P€RMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INOIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> STATE MILITARY DEPT iISTAbcro ( ) 01 FED ( ) 02 STATE f 1 03 LOCAL <br /> STREET ADDRESSp CITY STATE ZIP <br /> •p-eC 43, Aa/ SACRAMENTO CA 95621 <br /> II FACILITY <br /> FACILITY NAME [/ - :DEALER/FOREMAN/SUPERVISOR <br /> STREET ADDRESS L/ NEAREST CROSS STREET <br /> GO AQ toAIRPORT WAY STIMSON <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITYSTATE ZIP <br /> STOCKTON CA 95206 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 01 GASOLINE STATION (X) 02 OTHER MAINT SHOP/FUEL STOP <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 0 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHCNE W/AREA CODE <br /> M�FTLt2LlR'DrtYiC 209-369-43ii !� �j MARQUIS JOHN 209 <br /> 1'1156r �c��. cs' <br /> --"'CIINFLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. f 1 01 TANK (X) 04 OTHER: 1MP CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED tct&_5 M+UNKNOWN <br /> D. CONTAINER CAPACITY: 300 GALLONS ( ] UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES1: <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL (X) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE f 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) !:-q 02 NON-VAULTED 4*r'03 UNKNOWN <br /> C. V 01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( 1 03 LINED <br /> 0. O1 CARBON STEEL f ) 02 STAINLESS STEEL l ) 03 FIBERGLASS ( ) C4 POLYVINYL CHLORIDE-Allip CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( l O8 BRONZE ( 1 09 COMPOSITE ( 1 10 NON-METALLI <br /> (9H 12 UNKNOWN ( 1 13 OTHER: <br /> HSC04-070185 (10/18/851 PAGE 1 <br />