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STATE ID NUMBER 000000084%005 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> 01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TAMC CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 1 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( 1 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION,INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> HERMAN E HELEN'S MARINA, A CAI(�(7,)l(( ( ) 01 FED ( l 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> 15135 WEST END 8 MILE ROAD STOCKTON CA 95209 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> HERMAN A 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 ADDRESS CITY STATE2IP <br /> VENICE ISLAND FERRY STOCKTON CA 95209 <br /> PHONE W/APEA CODE TYPE OF 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 FIRST) AND PHONE W/APEA CODE NIGHTS: NAME(LAyyqT] NAME FIRST) AND PHONE W/AREA CODE <br /> SMITH, DAVID M. 209-951-4634 l�'.�L�//IA'(7TWjr.(z 7' -?!itV&_jFV <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 5 <br /> B. MANUFACTURER (IF APPROPRIATE): UNK YEAR MFG= C. YEAR INSTALLED 1980 ( 7 UNKNOWN <br /> D. CONTAINER CAPACITY: 300 GALLONS ( ) UNKNOWN E. ODES TME CONTAINER STORE: ( ) 01 WASTE (XI 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ESI: <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM ( ) 04 DIESEL l ) 05 WASTE OIL (X) 06 OTHER OIL <br /> V CrItTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE ( ) INCHES ( ) CM (X) UNKNOWN <br /> B. l I 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( 1 01 CARBON STEEL ( 7 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM ( 1 07 STEEL CLAD f ] 08 BRONZE ( ) 09 COMPOSITE ( ) 10 NON-METALLIC <br /> f l 12 UNKNOWN (X) 13 OTHER: STEEL <br /> HSC04-070185 (10/18/85) PAGE 1 <br />