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STATE ID NUMBER 00000031535001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> ( ) 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> ( ] 02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPORATION•INDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY OF STOCKTON-MUNICIPAL ( ) 01 FED ( ) 02 STATE 06 03 LOCAL <br /> STREET ADO P,ESS CITY STATE ZIP <br /> 2500 NAVY DRIVE STOCKTON CA 95206 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> DON AVENUE STORM STATION JERRV-t*t9Wr SUPERVISOR <br /> STREET ADDPESS NEAREST CROSS STREET <br /> DON AVENUE MOSHER SLOUGH COLONIAL DRIVE <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95209 <br /> MAILING ADDRESSCITY STATE ZIP <br /> 2500 NAVY DRIVE STOCKT0 CA 95206 <br /> PHONE W/AREA COOP. TYPE OF BUSINESS <br /> 209-466-SO l� ( ) 01 GASOLINE STATION (XI 02 OTHER DIESEL <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP 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 FIPST) AND PHONE W/AREA CODE <br /> OPERATOR IN CHARGE 209-466 91!63 OPERATOR IN CHARGE 209-466-1Ebd <br /> A` <br /> COMPLETE THE FOLLO EPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: ICONTAINER NUMBER 1 <br /> B. MANUFACTURER (IF APPROPRIATE): YEAR MFG: C. YEAR INSTALLED 1979 ( l UNKNOWN <br /> 0. CONTAINER CAPACITY: g3 GALLONS ( ) 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 f 1 05 WASTE OIL f ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: 12 (X) GAUGE f 1 INCHES ( ) CM ( ) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) fM 02 NON-VAULTED ( ) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (X) 02 SINGLE WALLED ( 1 03 LINED <br /> D. 00 01 CA ( ) 02 STAINLESS STEEL f 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE f 1 05 CONCRETE <br /> ALUMINUM �07 STEEL CLAD ( ) 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> ( ) 12 UNKNOWN f <br /> HSC04-070185 (10/18/85) PAGE 1 <br /> ice/ v..i <br />