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(QEF117-a- L <br /> STATE IO NUMBER 00000037550002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> t,'<i 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED 09 DELETE FROM FILE (NO FEEL <br /> ( ) 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHAR <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> STATE MILITARY DEPT. ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE IIP <br /> 2829 WATT AVE SACRAMENTO CA 95821 <br /> II FACILITY <br /> FACILITY NAME6l'wff/N__lo <br /> STOCKTON GGNSOM SUPPORT MAINTb�/N�46 S/f/P �efhis) EALER/FOREMAN/SUPERVI OR <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 6888 SOUTH AIRPORT WAY <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAiIING ADDRESS CITY STATE ZIP <br /> VAct <br /> STOCKTON CA 95BE3.gSj2O <br /> PHONE W/AR.EA CODE TYPE OF BUSINESS <br /> 209-982-4544 ( ) 01 GASOLINE STATION (X) 02 OTHER MAINT SHOP <br /> NUMBER OOFf CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> r 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAST NAME FIRST) ANG PHONE W/AREA CODE <br /> STAFF 209-982-4544 �tJ <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> S. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED ( 1 UNKNOWN <br /> 0. CONTAINER CAPACITY: GALLONS ( 1 UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE f ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? f ) 01 YES ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (x) UNKNOWN <br /> B. f l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ) 02 SINGLE WALLED f l 03 LINED <br /> 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( 1 OS CONCRETE <br /> f ) 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE l ) 09 COMPOSITE l ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />