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STATE ID "JMBE 00000064060002 ' <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (x) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> HICKINBOTHAM BROS LTD f ) 01 FED ( l 02 STATE f ) 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> A <br /> SO. RORA ST STOCKTON CA 95201 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> A" <br /> HICKINBOTHAM BROS LTD /}A� AA AAM <br /> STREET ADDRESS / NEAREST CROSS STREET <br /> 92+4"444.� 6�� - ,Qr� AURORA ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95201 <br /> MAILING ADDRESS w CITY STATE ZIP <br /> P.O. Be*.w O ( j�/v STOCKTON CA 95201 <br /> PHONE W/APIA CODE TYPEOF BUSINESS <br /> 209-9 *"m 9 � Z ( 1 01 GASOLINE STATION (X) 02 OTHER STEEL SERVICE CENTER <br /> NUMBER OF CONTAINERS PUPAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 4 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODED NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/APSA CODE <br /> 3 <br /> 201-94e-r 9 Z -7 y 2 Z► 209-9as-84 1 (F Z. <br /> '41- <br /> CA e <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: 1974 C. YEAR INSTALLED 1974 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 12500 GALLONS f ) 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 ( 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> (X) 01 UNLEADED f 1 02 REGULAR f l 03 PREMIUM ( ) 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( 02 SINGLE WALLED ( l 03 LINED <br /> D. (X) 01 CARBON STEEL f 1 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE l ) 05 CONCRETE <br /> f ) 06 ALUMINUM ( ) 07 STEEL CLAD l ) 08 BRONZE l ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />