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STATE ID NUMBE 00000064060003 <br /> yy APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (q1 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TAMC 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 OROS LTO ( ) 01 FED f ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 436 SO. AURORA ST STOCKTON CA 95201 <br /> _j.- <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPE VISOR <br /> HICKINBOTHAM BROS LTD o,#-,' OLIAX,uv�¢. <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 920.MkEEf-iEft3T > a`., _ �„, AURORA ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95201 <br /> MAILING ADDRESS CITY STATE ZIP <br /> p Q _ STOCKTON CA 95201 <br /> PRONE W/AREA CODE TYPEOF BUSINESS <br /> 20r-T..-idz"-'� ..� - s� ( 1 O1 GASOLINE STATION (X) 02 OTHER STEEL SERVICE CENTER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <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 /> STAUG89-UMT 209-946-'11v 9y -L-Z eTR yam+ 1 209-94&-"&T <br /> ht()W "*AW&4A4q &Z^ <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 /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1974 C. YEAR INSTALLED 1974 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 12500 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 ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( l GAUGE f ) INCHES ( I CM (X) UNKNOWN <br /> B. ( l 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f 1 01 DOUBLE WALLED (lA 02 SINGLE WALLED ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( 1 02 STAINLESS STEEL l ) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ] 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( 7 10 NON-METALLIC <br /> ( ) 12 UNKNOWN ( ) 13 OTHER: <br /> MSC04-070185 (10/18/85) PAGE 1 <br />