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STATE ID NUMBER 00000004086002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ifLD1 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ] 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> N4ME(COPPORATION.INDIVIDU L OR PUBLIC AGENCY PUBLIC AGENCY ONLY <br /> .L� I ( ) 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> fa o STOCKTON CA 95209 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CONSTRUCTION YARD D. L. SEIBOLD <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 820 S. AMERICAN WORTH <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN +95846_ q'S mlB�j <br /> MAILING ADOPESS CITY STATE ZIP <br /> P.O. BOX 8744? STOCKTON CA 96208 <br /> PHONE W/AREA COD'- TYPE OF BUSINESS <br /> 209-948-2152 f 1 01 GASOLINE STATION (X) 02 OTHER CONST. YARD <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIPRANGE 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 /> SEISOLD. DARRYL <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER R2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1968 FC, YEAR INSTALLED 1968 f l UNKNOWN <br /> 1004 <br /> D. CONTAINER CAPACITY: -"0- GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f 1 01 WASTE (X) 02 PRODUCT <br /> F. DES TCONTAINER STORE MOTOR VEHICLE FUEL OR WA OIL ? (X) 01 YES f 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 0HE1 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 3/16^ ( ) GAUGE (X) INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED 1 ) 03 LINED <br /> D. (X) 01 CARBON STEEL 1 ) 02 STAINLESS STEEL ( l 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> ( ) 06 ALUMI" ( ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f ) 12 UNKNOWN ( ). 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />