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IQEHoVf� / STATE ID NUMB 0006406 ' <br /> APPLICATION FOR PERMIT TO ERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( 1 0 r)nc l ) 09 DELETE FROM FILE (NO FEE) <br /> ( 1 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT f '�{� (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INOIVIDUAL OR PUBLIC AGENCY) .PUBLIC AGENCY ONLY <br /> HICKINBOTHAM BROS LTD ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> !'!B SO. AURORA ST STOCKTON CA 95201 <br /> I1 FACILITY <br /> FACILITY NAME DEALER/FOR4�/EM}N/SU ERV�ZSLO�R�� <br /> HICKINBOTHAM BROS LTD Z1 MVM r�r <br /> STREET ACTRESS �� / NEAREST CROSS STREW <br /> y{� <br /> 980-HAZEZTpH- � `J AURORA ST. <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95201 <br /> MAILING ADDPESS CITY STATEZIP <br /> P.O�^V L= ��� S? 3TOCKTON CA 95201 <br /> PHOOF BUSINESS <br /> 209Nr W-9aa�rrer CODE 2, _ytI� T(P) 01 GASOLINE STATION (X) 02 OTHER STEEL SERVICE CENTER <br /> NUMBER OF ONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> a <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 /> srereae,-mw 209"*S�+�3 Z. o , STEVe""-MM 209-gas-e"l f(/-L —qq-z ?, <br /> ,4U-pA.1 Ott ,VrVkN AJ " <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. ( ) 01 TANK (X) 04 OTHER: 3 CONTAINER NUMBER 0000000001 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1974 C. YEAR INSTALLED 1974 ( ) UNKNOWN <br /> O. CONTAINER CAPACITY: 500 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: (X) 01 WASTE ( ) 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 ( ) 04 DIESEL (X) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f ) 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 ( ) 03 LINED <br /> D. (X) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM l 1 07 STEEL CLAD ( ) 08 BRONZE ( ) 09 COMPOSITE ( ] 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> NSC04-070185 (10/18/85) PAGE 1 <br />