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STATE ID NUMBER 00000064424001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERG OUND STORAGE TANK <br /> ( 1 01 NEW PERMIT ( ) 05 RENEWED PERMITf f 1 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT 08 MINOR CHANO SURCHARGE) <br /> I OWNER <br /> NAME(COPPCRATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> SALLW4 ES 3JG km Ntwfrgmr2e6 ( ) 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADOPESS CITYSTATE ZIP , jam <br /> aD 3177„1 _A 44r.- WAt"UT-ter o CA 44s9s�""7 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> SAFEWAY SPECIALTY SAUSAGE PLAN <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1320 S. AURORA STREET CHARTER WAY <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95206 <br /> MAILING ADDRESSCITY STATE ZIP <br /> P.O. BOX 8779 STOCKTON CA 95208 <br /> /APEA COD <br /> OF BUSINESS <br /> PHONE <br /> EE W1 '&Y T(P) 01 GASOLINE STATION (X) 02 OTHER SAUSAGE PLANT <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 /> ED STRANGE 209-745-3821 M.H. MORSE 209-951-7295 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 4000 GALLONS f 1 UNKNOWN E. DOES THE CONTAINER STORE: f ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WAjTj OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> f 1 01 UNLEADED ( ) 02 REGULAR ( 1 03 PREMIUM f 04 DIESEL ( 1 05 WASTE OIL (X) 06 OTHER EMPTY <br /> V CONTAINER CONSTRUCTION / <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) ( ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( Y01 DOUBLE WALLED ( 1 02 SINGLE WALLED ( 1 03 LINED <br /> D. 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ) 06 ALUMINUM ( ) 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( 1 10 NON-METALLIC <br /> ,;N2 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> n <br />