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STATE ID NUMBER 00000004086001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ("j 01 NEW PERMIT [ ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED f l 09 DELETE FROM FILE (NO FEE) <br /> ( l 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION�INDIVIDUAL OR PUBLIC AGENCY),., PUBLIC AGENCY ONLY <br /> li��✓( l/j/- ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS A� CITY STATE ZIP <br /> SITCKTON CA 95209 <br /> II FACILITY <br /> FACILITY NAME �f�d�� DEALER/FOREMAN/SUPERVISOR <br /> . • D. L. SEISOLD <br /> STREET ADDRESS NEAREST CROSS STREET <br /> §20 S. AMERICAN WORTH <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN .9512-06 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX •344•2.�y, STOCKTON CA 95208 <br /> PHONE W/AREA CCCE TYPE OF BUSINESS <br /> 209-948-2152 ( ) 01 GASOLINE STATION (X) 02 OTHER CONST. YARD <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 3 <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 /> SEIBOLD, DARRYL 209i54'(�-��7i o <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 01 <br /> B. MANUFACTURER (IF APPROPRIATE): PERKINS YEAR MFG: 1968 C. YEAR INSTALLED 1968 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 2000 GALLONS 1 ) UNKNOWN E. DOES 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 /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: .35" f ) GAUGE (X) INCHES ( ) CM ( ] UNKNOWN <br /> B. l l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( 1 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED l ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL f ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE f ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />