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STATE ID NUMBER 00000040625001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> . ( 1 02 CONDITIONAL PERMIT l ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CAPITAL VENTURE ENTERPRISE ( ) 01 FED f ) 02 STATE f l 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 2223 LAKE ST #306 SAN FRANCISCO CA 94121 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> BEAULIEN CHEMICAL HERB BOND <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 400 S. AURORA ST CHURCH <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAGUIN 95204 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 400 S. AURORA ST STOCKTON CA 95204 <br /> FHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-4151 ( 1 01 GASOLINE STATION (X) 02 OTHER CHEMICALS <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 1 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> '��PI.YS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NZCXTS: NAMF(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> BAYCEr BEN 43G.G32_6t4l HUTHr RUSSELL 415-752-0495 <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> S. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: GALLONS IX) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( l 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? ( ) 01 YES (X) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) <br /> 01 UNLEADED f ) 02 REGULAR ( 103 PREMIUM f ) 04 DIESEL f 1 05 WASTE OIL l ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( I GAUGE f ) INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( l 02 SINGLE WALLED f 1 03 LINED <br /> 0. ( 1 01 CARBON STEEL f l 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ] 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> [ ) 06 ALUMINUM f ) 07 STEEL CLAD ( ) 08 BRONZE ( l 09 COMPOSITE f l 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> t <br />