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STATE ID NUMBER 00000031634001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (Xl 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> Y7-'02 CONDITIONAL PERMIT f ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAMC(COPPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON ( ) 01 FED ( ) 02 STATE L3V 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 425 N. EL DORADO STREET STOCKTON CA 95202 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> OAK PARK tcg_ ,Y�q_ MARY RICHARDSON <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 3545 N. ALVARADO AVE. ALPINE AVE. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95204 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 425 N. EL DORADO ST. ROOM 301 STOCKTON CA 95202 <br /> PHONE W/APIA CODE TYPE OF BUSINESS <br /> 209-941-8432 ( 1 01 GASOLINE STATION (X) 02 OTHER ICE ARENA/PARK <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SCCTION <br /> I <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> RICHARDSON, MARY 209-941-8432 RICHARDSON. MARY 209-952-1191 <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 /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 550 GALLONS f ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 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 /> ( ) <br /> 01 UNLEADED (X) 02 REGULAR ( l 03 PREMIUM ( ) 04 DIESEL f 105 WASTE OIL [ ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED 04 02 SINGLE WALLED [ 1 03 LINED <br /> D. (XI 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD [ l 08 BRONZE f 7 09 COMPOSITE f ) 10 NON-METALLIC <br /> ( 7 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br /> 7/ \wf <br />