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STATE ID NUMBER 00000004086003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 04 01 NEW PERMIT f ) 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 /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> L) f 1 01 FED ( 1 02 STATE f 1 03 LOCAL <br /> STREET ADDP.ESS p� CITY STATE ZIP <br /> 30} peffAeE-ih no t C/q'f� STOCKTON CA 95209 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> CONSTRUCTION YARD 0. L. SEIBOLD <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 820 S. AMERICAN WORTH <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 96296 <br /> MAILING ADDRESS CITY STATE ZIP <br /> P.O. BOX�4- $' STOCKTON CA QSew•�i ZCTd <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-948-2152 f 1 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 NIOH TS: NAME)LAST NAME FIRST) AND PHONE W/AREA CODE <br /> SEIBOLD. DARRYL 209-466-}455' tj Z 6r_A1MCC) -W ©q� <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 03 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1968 C. YEAR INSTALLED 1968 1 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 8000 GALLONS [ 1 UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIt ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( 1 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 3/8'. ( ) 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 ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL ( ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> ( ) 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE f 1 10 NON-METALLIC <br /> t ) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />