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STATE ID NUMBER 00000008496003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 24y,01 NEW PERMIT [ l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ) 02 CONDITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAMT(CORPOPATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> HERMAN A HELEN'S MARINA, A CALL Pd j21wo/v ( ) 01 FED [ 1 02 STATE f ) 03 LOCAL <br /> STREET ADDRESS CITYSTATE ZIP <br /> 15135 WEST END 8 MILE ROAD STOCKTON CA 95209 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> HERMAN B HELEN'S MARINA DAVID M. SMITH <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 15135 WEST END 8 MILE ROAD EMPIRE TRACT ROAD <br /> CITY COUNTY IF <br /> STOCKTON SAN JOA9UEN 95209 <br /> MAILING ADDRESSCITY STATE ZIP <br /> VENICE ISLAND FERRY STOCKTON CA 95209 <br /> PHONE W/AREA CODE TYPEOF BUSINESS <br /> 209-951-4634 (X) 01 GASOLINE STATION f ! 02 OTHER <br /> SECTION <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE <br /> 5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE NIGHTST:cNIAA�MM7�EE(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> SMITH, DAVID M. 209-951-4634 V(cs,.iF`� f4y- T <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 3 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG: C. YEAR INSTALLED (X) UNKNOWN <br /> D. CONTAINER CAPACITY: 1000 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: f ) 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(ESY: <br /> ( ) 01 UNLEADED ( ) 02 REGULAR l ) 03 PREMIUM (X) 04 DIESEL f ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f 1 GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. ( 7 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. ( ) 01 CARBON STEEL f l 02 STAINLESS STEEL f 7 03 FIBERGLASS f 1 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ] 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE f l 10 NON-METALLIC <br /> [ 1 12 UNKNOWN (X) 13 OTHER: STEEL <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> Now *.I <br />