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4t 141 <br /> STATE I0 HUMBER 00000066667002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT f 1 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 /> OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> P.E. O'HAIR A CO. ( ] 01 FED ( 1 02 STATE ( l 03 LOCAL <br /> STREET ADDRESS - CITY STATE IIP <br /> 840 BRANNAN ST. SAN FRANCISCO CA 94103 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> P.E. O'HAIR A CO. RICHARD RATLIFF <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1102 SOUTH AURORA ST. <br /> CITY COUNTY IIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESS CITY STATE IIP <br /> P.O. BOX 1529 STOCKTON CA 95201 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-948-6801 ( ) 01 GASOLINE STATION (X) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTS: NAMEILAST NAME FIRST) AND PHONE W/AREA CODE <br /> IRATLIFF, RICHARD 209-948-8801 RATLIFF, RICHARD 209-477-0433 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK [ 1 04 OTHER: CONTAINER NUMBER i2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 10000 GALLONS ( ) 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 t ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( 1 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM (X) 04 DIESEL 1 ) 05 HASTE OIL ( ] 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) tX) 02 NON-VAULTED ( ) 03 LWHOWNN <br /> C. t ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED [ 103 LINED <br /> D. (X) 01 CARBON STEEL f l 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> f ) 06 ALUMINA) ( 7 07 STEEL CLAD ( ) 08 BRONZE [ 1 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (08/29/86) PAGE 1 <br />