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1%00 Nomol STATE ID NUMBER 00000059148002 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ()0 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK <br /> 1 2 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MI14ORCLOSED ( I 09 DELETE FROM FILE (NO FEEL <br /> CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(COPPORATION,INDUseIVIDUAL OR PU6 LIC A ENCY) PUBLIC AGENCY ONLY <br /> I [ 1 01 FED ( 1 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE LIP <br /> 130K INQ <br /> CA <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> KING ISLAND R{?88Rfi"8"MARINA 3 <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 11530 WEST EIGHT MILE RD. INTERSTATE 5 <br /> CITY COUNTY IIP <br /> STOCKTON SAN JOAQUIN 95209 <br /> MAILING ADDRESS CITY STATE zip <br /> 11530 WEST EIGHT MILE R0. STOCKTON CA 95209 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-4/8�4E _ (X) 01 GASOLINE STATION f l 02 OTHER <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 /> ft&PFEA$TEIFTLARRY 209 3� -itON 209-4;4-39" Z <br /> PETE FOLLOWING ON A SEPAAMKM rUK EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 2 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED (X1 UNKNOWN <br /> D. CONTAINER CAPACITY: G GALLONS (W UNKNOWN E. DOES THE CONTAINER STORE: ( 1 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL DR WASTE OIL ? (X) 01 YES f 1 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED (X) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL ( ) 05 WASTE OIL f 1 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f ) GAUGE f 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 ( ) 03 LINED <br /> D. f 1 01 CARBON STEEL ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( l 04 POLYVINYL CHLORIDE f ) 05 CONCRETE <br /> ( 1 06 ALUMINUM ( ) 07 STEEL CLAD f ) 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> NSC04-070185 (10/18/85) PAGE 1 <br />