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STATE ID NUMBER 00000052051003 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> tXl 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TANK CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> 02 CONDITIONAL PERMIT ( l 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAME(CORPOPATIONrINDIVIOUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> AN TYE BROS. ( ) 01 FED ( ) 02 STATE ( 1 03 LOCAL <br /> STREET ADDRESSCITY STATE ZIP <br /> 308 S. EL DORADO STGCKTDN CA 95203 <br /> II FACILITY <br /> FACILITY NAME DEALER/FOREMAN/SUPERVISOR <br /> AN TYE BROS. SAM FONG <br /> ILTREET ADDRESS NEAREST CROSS STREET <br /> 308 S. EL DORADO LAFAYETi E <br /> CITY COUNTY ZIP <br /> STOCKTON SAN JOAQUIN 95203 <br /> MAILING ADDRESS CITY STATE IIP <br /> 308 S. EL DORADO STOCKTON CA 95203 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-466-2924 (X) O1 GASOLINE STATION ( ) 02 OTHER <br /> NUMBER OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANGE SECTION <br /> 4 <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/AREA CODE <br /> FONG, SAM 209-466-2924 SAME Jf/?�Q?C,;;- <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER 01 <br /> B. MANUFACTURER (IF APPROPRIATE): BUCKEYE 717 YEAR MFG: C. YEAR INSTALLED 1960 ( ) UNKNOWN <br /> D. CONTAINER CAPACITY: 8000 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 /> (X) 01 UNLEADED f ) 02 REGULAR ( ) 03 PREMIUM f 1 04 DIESEL ( l 05 WASTE OIL ( ] 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: ( 1 GAUGE ( 1 INCHES f l CM (X) UNKNOWN <br /> B. ( ) 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f 02 NON-VAULTED (.V.1-03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED ( ] 02 SINGLE WALLED ( ) 03 LINED <br /> D. ( ) 01 CARBON STEEL [ l 02 STAINLESS STEEL ( 1 03 FIBERGLASS ( 1 04 POLYVINYL CHLORIDE [ 1 05 CONCRETE <br /> ( ) 06 ALUMINUM ( ) 07 STEEL CLAD ( 1 08 BRONZE ( 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> KSC04-070185 (10/18/85) PAGE 1 <br /> 1.r 4. <br />