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STATE I0 NUMBER 00000008496004 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> Aj 01 NEW PERMIT ( l 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> l ) 02 CONDITIONAL PERMIT f 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> HERMAN A HELEN'S MARINA, A CAL�}'��L(( (QrE� ( ) 01 FED f 1 02 STATE ( 1 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 8 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 ZIP <br /> STOCKTON SAN JOAQUIN 95209 <br /> MAILING ADOPESS CITY STATE ZIP <br /> VENICE ISLAND FERRY STOCKTON CA 95209 <br /> PHONE W/ARCA CODE TYPEOF BUSINESS <br /> 209-951-4634 (X) 01 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY TOWNSHIP RANGE SECTION <br /> 5 <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRSTI AND PHONE W/AREA CODE NIGHTS: NAME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> SMITH, DAVID M. 209-951-4634 TAME- <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( 1 04 OTHER: CONTAINER NUMBER 4 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG: C. YEAR INSTALLED 1980 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 500 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 f ) 02 NO IF YES CHECK APPROPRIATE SOX(ES): <br /> f 1 01 UNLEADED ( l 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL l ) 05 WASTE OIL (XI 06 OTHER 50/1 MIXED FUEL <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE f 1 INCHES ( ) CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. f ) 01 DOUBLE WALLED (X1 02 SINGLE WALLED f 1 03 LINED <br /> 0. f ) 01 CARBON STEEL [ 1 02 STAINLESS STEEL f 7 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( ) 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 108 BRONZE f 109 COMPOSITE ( 7 10 NON-METALLIC <br /> f ) 12 UNKNOWN (X) 13 OTHER: STEEL <br /> KSC04-070185 (10/18/85) PAGE 1 <br />