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%ago, STATE ID NUMBER 00000034492002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK CLOSED <br /> ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> PUBLIC AGENCY ONLY <br /> NAME(COP POR AT ION,IND IVIOUA L OR PUBLIC AGENCY) ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> ALBERT BAROSSO <br /> CITY STATE ZIP <br /> STREET ADDRESS STOCKTON CA 95205 <br /> 3939 N. ARATA RD. <br /> II FACILITY <br /> DEALER/FOREMAN/SUPERVISOR <br /> FACILITY NAME <br /> ALBERT BAROSSO RANCH <br /> NEAREST CROSS STREET <br /> STREET ADDRESS <br /> 3939 N. ARATA RD. <br /> COUNTY ZIP <br /> CITY SAN JOAQUIN 95205 <br /> STOCKTON <br /> CITY STATE ZIP <br /> MAILING ADDRESS STOCKTON CA 95205 <br /> 3939 N. ARATA RD. <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-931-3222 ( ) 01 GASOLINE STATION (X) 02 OTHER FARMING <br /> RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> NUMBER OF CONTAINERS O'N <br /> 2 <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 /> BAROSSO ALBERT 209-931-3222 SAME - <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS (X) UNKNOWN E. DOES THE CONTAINER STORE: ( ) O1 WASTE ( ) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( 1 01 YES ( l 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 0 <br /> 1 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( 1 04 DIESEL ( ) 05 WASTE OIL ( 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS Of PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. l i Ol DOUBLE WALLED ( ) 02 SINGLE WALLED ( l 03 LINED <br /> D. ( 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE f ) 09 COMPOSITE ( 1 30 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> MSC04-070185 (10/18/851 PAGE 1 <br />