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STATE ID NUMBER 00000059536001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> CLOSED01 NEW PERMIT ( 1 05 RENEWED PERMIT ( ) 07 TANK ) 09 DELETE FROM FILE (NO FEE) <br /> -r-) 02 CONOITIONAL PERMIT ( ) 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION.INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> Gif--SPRiiFT // 9, ( ] 01 FED ( ) 02 STATE ( ) 03 LOCAL <br /> STREET ADDRESS CITY STATE ZIP <br /> ONE ADRIAN COURT BURLINGAME CA 94010 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERV OR <br /> PIXLEY JUNCTION "PXY" <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 6855 W. EIGHT MILE ROAD INTERSTATE 5 <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95209 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 6855 W. EIGHT MILE ROAD STOCKTON CA 95209 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-957-8684 ( ) 01 GASOLINE STATION (X) 02 OTHER TELECOMMUNICATIONS <br /> NUMBER OF CONTAINERS RURAL AREAS ONLYTOWNSHIP RANGE SECTION <br /> 1 <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/ARE ! EllR� <br /> •/FRYTeE __ 4 (/ <br /> n(, <br /> „M• ETE THE FOLLOWING ON A SEPARAT FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: 1983 C. YEAR INSTALLED 1983 ( 1 UNKNOWN <br /> D. CONTAINER CAPACITY: 6000 GALLONS ( 1 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 ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( ) GAUGE [ l INCHES ( 1 CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) (X) 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED f ) 03 LINED <br /> 0. ( ) 01 CARBON STEEL f ) 02 STAINLESS STEEL (X) 03 FIBERGLASS f ) 04 POLYVINYL CHLORIDE ( 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( l 07 STEEL CLAD f ) 08 BRONZE f l 09 COMPOSITE ( l 10 NON-METALLIC <br /> ( 1 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />